College of Health & Social Care
Declaration on Conduct of Assessed Work
(Academic Good Conduct)
Assessed work which does not have this form attached will be returned unmarked.
Module _________________________________________________________________________
Assignment title______________________________________________________________________
Briefly, unfair means in assessed work is likely to fall into one or more of the following categories:
- Plagiarism
- Plagiarism involves taking the work of another person or source and using it as if it were one’s own. Work includes, but is not restricted to, written work, ideas, musical compositions, computer programs, laboratory or survey results, diagrams, graphs, drawings and designs.
- Collusion
- Collusion involves working with others on tasks that should be carried out on an individual basis. Collusion should not be confused with collaborative work which is sometimes used as a means of learning. It will be clearly stated when collaborative work is permitted in an assessment. Unless advised otherwise, any work which is submitted for assessment must be produced by individual students.
- Falsifying experimental or other investigative results
- This could involve a range of things that make it appear that information has been collected by scientific investigation, the compilation of questionnaire results, etc. whereas in reality it has been made up or altered to provide a more favourable result.
- Contracting another to write a piece of assessed work / Writing a piece of assessed work for another
- This involves any means whereby a person does work on behalf of another. It includes assessments done for someone else in full or in part by a fellow student, a friend or family member. It includes sitting an examination for someone else. It also covers obtaining material from internet ‘cheat sites’ or other sources of work. Penalties for this type of unfair means will normally apply both to a student who does work on behalf of another and one has work done for him/her.
I declare that:
- This work is my own.
- If this is a group project, each student has contributed to the work in accordance with the set criteria.
- The work of others used in its completion has been duly acknowledged.
- Experimental or other investigative results have not been falsified.
- I have read and understood the University Policy on the Conduct of Assessed Work (Academic Misconduct Procedure) *.
Signature………………………………………………………………………………….
Name (print)……………………………………………………………………………….
ID Number…………………………………………………………………………………
Date………………………………………………………………………………………….
https://monkessays.com/write-my-essay/academic.salford.ac.uk/aqa/sections/28_conduct_assessed_work_pdf
It is the student’s responsibility to be aware of this policy and procedure.
Table of Contents
1.3 Other Leadership Models. 10
1.3.1 Transformational Leadership Style: 10
1.3.2 Transactional Leadership. 13
1.3.3 Authentic Leadership Style (ALS) 13
1.3.4 Emotional intelligence. 15
2.4.4 Inclusion and Exclusion. 23
3.2 Historical Aspects of Servant Leadership. 27
3.3 Modern Servant Leadership Theory. 28
3.4 Measures of Servant Leadership. 37
3.5 Conceptual Framework for Servant Leadership. 40
4.0 Homework help – Discussion. 47
4.2 Homework help – Discussion. 47
4.2.1 Servant leadership in healthcare organization. 47
4.2.2 Servant Leadership in Business. 54
4.2.3 Servant leadership in Education. 55
5.0 Conclusion and Recommendations. 57
ACKNOWLEDGMENTS
Writing this dissertation was one of the significant milestones in my academic journey. Without the support of Allah, my supervisor, family and friends, I could not have completed this dissertation. I would like to express my gratitude to Dr. Michael Lappin and June Rutherford whom I owe special thanks for his help and encouragement in making this dissertation possible. It has been a pleasure being one of his students. I would like to thank him for his time and patience throughout the dissertation writing period. His knowledge, commitment and wisdom has inspired and motivated me during my academic journey. Secondly, I want to thank my family: father (Malfi) mother (Norah), brothers and sisters for their support and prayers. Finally, I would like to thank my organization in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia, for the help granted during the writing process, and more so, my friends for their help and support.
Abstract
This study explored the relationship between servant leadership and the productivity of both servant leaders and followers. The aim of this systemic review was to examine relevant literature, in order to determine whether or not servant leadership positively influences the productivity of both servant leaders and their followers in healthcare organisations. In that regard, the guiding in this systematic review is that servant leadership is the best model for healthcare organisations because it focuses on the strength of the team; developing trust and serving the needs of patients.
The theories developed by Greenleaf, research studies concerning servant leadership by Spears (1995), Barbuto and Wheeler (2006) Sendaya, Sarros and Santora (2008), and Russell and Stone (2002) were heavily relied on. Various databases were also consulted, including MEDLINE, Pub Med, the Cumulative Index to Nursing and Allied Health (CINAHL), as well as the Cochrane Library and Science Direct. These provided relevant articles for review, with 12 studies being identified. The results of this systematic review showed that the theories support the assertion that a healthcare organisation succeeds when led by a servant leader. The conclusion of this systematic review was that healthcare organisations attract servant leaders and followers who work towards the aim of growing and building a consensus in differing atmospheres, as well as providing important healthcare services to the community.
Keywords: Servant leadership, Leadership, healthcare
CHAPTER I
1.0 Introduction
The hospital in question is one of the most advanced health facilities in Riyadh, Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia, and is committed to the provision of the best healthcare services to the constituents it serves. This includes, but is not limited to, meeting the expectations of the workers and the healthcare it serves, the provision of optimum support to the employees and the improvement of its operations to achieve the organisational mission and vision which is provide the highest levels of patient care. This requires a certain level of servant leadership amongst the leaders and the followers who work within the different departments of the hospital. Anthony et al. (2005, p. 145) have argued that, in healthcare, it is important that managers exercise leadership which emphasises service amongst followers in order to guarantee their retention in the service of the hospital or health facility. Similarly, Anderson et al. (2010, p. 182) and Ashill, Carruthers and Krisjanous (2006, p. 271), have argued that the effectiveness and retention of healthcare staff can only be guaranteed through servant leadership, as exercised by the leader towards his/her followers. The implication of this is that servant leadership is positioned at the core of the operations of a hospital, and Riyadh Hospital is no exception.
The current style of leadership is an autocratic leadership, which may detrimentally affect the organisation and the employees. Autocratic leadership is concerned with providing orders to accomplish a task quickly. Employees are told what to do, how to do it and when to do it. They are subsequently observed to ensure that such tasks are completed well. Patients desire the highest quality of care, and its cost must also be reduced. To regain public trust, healthcare organisations must adapt to the current needs of patients. The diverse group of stakeholders in the healthcare organisation creates challenges for improving the value of care. Servant leadership has been chosen for this systematic review, in order to optimize the productivity of both servant leaders and the followers for people who require medical attention as it offers the most appropriate mode of leadership for providing healthcare services. This is because it focuses on care before a leader implements his/her leadership principles. It supports the philosophy of people who choose to serve first and lead followers in the provision of services through collaboration, trust, listening and the empowerment of others. This is related to the claim of Neill and Saunders (2008) that servant leadership incorporates a powerful skill set which can aid a collaborative approach to the delivery of healthcare practice. Following a servant leadership model in the application of such a management style would greatly facilitate and enhance the provision of services for people who require medical attention, as indicated by Swearingen and Liberman (2004), and Neill and Saunders (2008).
There were two reasons for choosing servant leadership, rather than another leadership style. To start with, servant leadership has similarities of structure with transformational leadership, authentic leadership and emotional intelligence, as presented in the tables below. Secondly, servant-leaders are those who attend to the needs of their followers, helping them to become more willing to accept the responsibilities entrusted to them, motivating them, and often learning about their followers’ needs, being ready to share their difficulties and frustrations (Schermerhorn et al., 2008; Yukl, 2006). This raises the question: what is the relationship between servant leadership and the productivity of both servant leaders and followers The aim of the systematic review is to examine the relevant literature to determine whether servant leadership positively influences the productivity of both servant leaders and their followers in healthcare.
1.2 Overview
Servant leadership has been practised in some basic form for at least 2,000 years (Joseph & Winston, 2005, p. 9). However, servant leadership as a concept was created by Robert Greenleaf (1970) who argued that there can be outcomes that would accrue to individuals who are led by servant leaders (Greenleaf, 1970, p. 1). Servant leadership, according to Greenleaf, is characterised by persons having two different roles, one as a servant and one as a leader to the followers. It begins with the intention to serve at first, and then consciously escalates to the aspiration to lead before leadership is eventually established (p. 7). This means that a servant leader must act in a certain manner which emphasises the offering of service to others through certain acts (De Pree, 2002, p. 89). This includes showing care for one’s followers, knowing the followers well, focusing on their needs, listening to them, providing vision, persuasion and building strong relationships with followers. In short, servant leaders must act in a way that causes followers to feel that they are appreciated for the service that they offer (Winston, 2004, p. 600). Service is therefore at the core of servant leadership, as it stresses the calling of a person or an orientation to offer service to his/her fellows within an organisation. Consistent display of servant hood by a servant leader is what causes the servant leader to be genuinely viewed as a servant leader exercising the ideals and objects of servant leadership (Sipe & Frick, 2009, p. 2).
In all organisations, leaders exist as long as there are followers to follow them out of their own free will (Greenleaf & Spears, 1998, p. 31). This, in turn, affects the usefulness of servant leadership to the followers, especially in terms of their growth in such areas as wisdom, freedom/autonomy and the probability that they will become servants in the future. Furthermore, it measures the effect of such a relationship in society at large, either directly or indirectly, through the participation of the servant leader and the follower. Servant leadership has been applied especially in the management of healthcare (Jackson, 2008, p. 27; Neill & Saunders, 2008; Neill, Hayward & Peterson, 2007; Swearingen & Liberman, 2004), and has also been witnessed in education institutions (Black, 2010; Sendjaya & Pekerti, 2010; Cerit, 2009). This theory focuses on the values inherent in the leader, rather than the external techniques that he/she employs in order to achieve the objectives, missions and visions of the organisation. Therefore, the failure or success of the servant leader is evaluated through a comparison of how he/she exercises leadership within the organisation (Russell, 2001, p. 81).
1.3 Other Leadership Models
In order to understand the development of the servant leadership model, it is important to analyze leadership models or styles that have contributed to its development and their significance in organisational behaviour and management. Understanding the unique natures of main leadership styles, such as transformational leadership, in addition to identifying features of the authentic leadership style (an improvised version of transformational style) are most important for a servant leader operating within the healthcare system. This helps one to optimise the performance and productivity of employees.
1.3.1 Transformational Leadership Style
Transformational leadership style aims to transform employees in such a way that they meet the dynamism required to the social, business and working environment; in addition to aligning the employee’s vision and mission with the organisational vision and mission (Bass, 1997). According to Greenleaf (1970), Transformational leadership emanated from performance excellence models and is aligned with total quality management, which requires organisational change (Evans & Lindsay, 2008, p. 646). It can be observed that the increasing demand for improvising human performance has created an increasing demand for the type of leadership that can inculcate universal and essential values and work ethics in workers. It also intrinsically motivates them to provide the best possible service, and transformational leadership offers the solution via its four “I”s, which are intellectual stimulation, individual consideration, idealised influence, inspirational motivation (Northouse, 1997). Thus by revealing several shades of leadership behaviour, this phase of learning virtually expanded the horizon of leadership practice (Bass 1985b, 1998).
For example, the significance of individual consideration, is encouraging empathizing with individual needs of the followers, building interpersonal connections with them and encouraging their continuous growth and development ( Bass,1990,1999; Bass&avolio,1993; Bauers Joslin 1996; Beatty&Brew,2004; Braga,2002) Similarly, intellectual stimulation, encourages the stimulation of imagination in employees (Smith et al,2004), challenging the old ways of doing things, looking for better ways to do things, encouraging the followers to think independently, and making them eager to take risks for potential gains. It does not take time for persons to realize that this package of leadership behaviour is a must item for servant leaders who are keen on meeting the current demands of the society, which require constant innovation and improvisation of services, especially in healthcare sector.
Inspirational motivation, the third type of leadership behaviour, identifies the leader’s responsibility to inspire the followers to perform (Smith et al, 2004), clarify the aims and objectives of organizational journey, create a strong sense of purpose among them, align their individual needs with organizational needs, and to help them achieve more than they initially estimated.
The above sets of leadership behaviour gradually shape an ideal leadership image, where the leader appears as someone who everybody would try to follow; as an epitome of developmental instrument. The fourth type of leadership behaviour, Idealized influence, helps to ‘see’ that leadership image more clearly, as it suggests demonstrating an inclusive vision, setting example through self-performance, projecting great commitment and persistence in pursuing objectives; expressing confidence in the vision of the organisation, and symbolising the goals and mission of the organisation (Avolio & Bass 1999).
The table below illustrates a comparison of Transformational Leadership, Servant Leadership and Transformational Theories.
| Transformational leadership | Servant leadership | |
| Group level | Leaders unites group to pursue group goals | Leader serve group to meet member needs |
| Moral component | unspecified | explicit |
| Nature of theory | normative | normative |
| Role of leader | To inspire followers to pursue organizational goal | To serve followers |
| Role of followers | To pursue organizational goals | To become wiser, freer ,and more autonomous |
| Outcomes expected | Goal congruence; increased effort, satisfaction and productivity; organizational gain | Follower satisfaction development, and commitment to service and societal betterment |
| Societal level | Leader inspire society to pursue organizational goals | Leader leaves a positive legacy for the betterment of society |
| Organizational level | Leader inspire followers to pursue organizational goal | Leader prepare organization to serve community |
| Individual level | Desire to lead | Desire to serve |
| Interpersonal level | Leader inspire followers | Leader serves follower |
Source: Adapted from Barbuto and Wheeler, 2006.
1.3.2 Transactional Leadership
Bass and Avolio’s (1997) Full Range of Leadership Model (FRLM), explained three distinguishable behavioural dimensions of transactional leadership, such as laissez-faire (hands-off leadership), management-by-exception (being absent from the working environment but expecting positive results) and contingent rewards (making a deal). It illustrates how transactional leadership at the contingent reward stage can form the platform for transformational leadership. Bass (1990) suggests that, through specific incentives, transactional leaders lead and motivate employees through the exchange of one thing for another or reciprocity. Bass (1985a) argued that by providing contingent rewards, the leader might inspire the subordinate to attain a certain degree of involvement, loyalty, and commitment. Bass also contended that transactional leadership used satisfaction of lower order needs as a primary means of motivation. Transactional leadership tended to lend itself to short-lived relationships since the gratification of those relationships was usually marginal and superficial (Fairholm, 1991). The transactional leader engaged in actions that may or may not have been beneficial to the subordinate (Bass, 1990). The purpose of any leader’s action was benefiting to the leader (Fairholm, 1991). Transactional leadership failed to consider the whole situation. It failed to take into account the employee or the future of the healthcare organization when offering rewards (Crosby, 1996).
1.3.3 Authentic Leadership Style (ALS)
According to Bhindi & Duignan (1997), decision-making processes in all organisations, especially healthcare organisations, are rather complex more often than not. Workers in the healthcare sector have observed that most problems emerge due to the absence of a clear and convincing ethical dictum, which, in turn, reflects the inadequacy of the leader and the need to acquire clear knowledge regarding all ethical dimensions associated with any particular situation (p.21). Klenke (2007) also emphasised that authentic leadership “specifies three interrelated identity systems: the spiritual-identity system, the leader-identity system, and the self-identity system. These are, in turn, comprised of multiple sub-identities that include affective, cognitive, and cognitive elements” (p. 68).The above state of affairs thus created the impression that ethical problems are consistent, as it is not always possible to identify which of the possible decisions are ethically strongest. ALS promotes a sense of ethics while accommodating the natural processes of development. This concept appears to be an important aspect of the learning curve, as it addresses the core of the problem. Bhindi & Duignan noted that ALS does this by suggesting that leaders need to achieve high self-esteem by being ethically right on every occasion.
Similarities between servant leadership and authentic leadership
Both servant leadership and authentic leadership are positivist leadership concepts that have much in common (Walumbwa, F., & May, D. 2004). Both leadership styles:
- Concentrate on serving, and granting power to, others.
- Emphasise certain values and adhere to such characteristics as compassion and passion.
- Strictly follow certain principles.
- Highly value relationships with people.
- Require charisma among leaders to ensure efficiency.
- Involve leaders who are motivated by their principles, instead of status or anticipation of recognition.
- Centre on developing individuals’ strengths, without emphasising weaknesses.
1.3.4 Emotional intelligence
In order to succeed in leadership and devolving emotional bonds, it is important that servant leaders learn to appraise, express and sense the emotions and feelings of others (Rapisarda, 2002). The first thing a leader needs to change is his/her emotional balance. In most cases of leadership failure, there exists an emotion that is not fitting to the situation; such as anger, anxiety, fear, disgust, trust, anticipation, sadness, and so on. This observation ratified the assumption that it is of utmost importance that a leader learns to control and direct his/her emotion to optimise leadership practice (Harvard Business review, 2015). That said, Goleman’s (1995) explanation of emotional intelligence (EI) appears to be the right guide to help transform from within. Goleman defined EI as a package of human capacity that enables them to recognize their own as well as others’ feelings, motivating the self as well as others, and managing emotions that emanate from all types of relationships. The above explanation explores the five elements of EI along with their subsets; self- awareness, self- regulation, motivation, empathy and social skills, which, according to Goldman, are the key drivers of EI in an individual.
EI is, therefore, the X-factor that could be instrumental in constantly motivating followers and increasing the productivity of organisations; especially those that are within the healthcare sector, which demand service even after scheduled working hours (more often than not) and where the professionals constantly need to control their emotions. Thus, the exploration of EI opened a new horizon of hope regarding effective exploitation of self and others’ emotions for the benefit of workers in the healthcare sector (Birks and Watt, 2007, p. 368).
While emotional intelligence was popularized by Goleman (1995), it was Salovey and Mayer’s (1990) followed by Mayer and Salovey’s (1997) who came up with a clear definition of emotional intelligence and leadership development. Mayer and Salovey posited that emotional intelligence has four elements: (a) the reflective regulation of emotion, (b) the ability to appraise and express emotion, (c) the ability to appraise and express emotion, and (d) the ability to appraise and express emotion. The application and usefulness of each of these four elements in servant leadership is based on the outcomes of the four elements that describe leader-follower relationship behavior: (a) altruism (b) Commitment, (c) affect-based trust, (d) Empathy, (e) responsiveness, (f) openness, and (g) caring and concerned behaviors.
This shows that seven leader-follower relational behaviors are similar to Mayer and Salovey’s four emotional intelligence factors, as well as the servant leadership models of Farling et al. (1999), Page and Wong (2000), Winston (2003), Sendjaya and Sarros (2003), Russell and Stone (2002) and Patterson (2003). The value of this, to realize the recognition of the similarities and overlap of the four emotional intelligence elements with servant leadership, is summarized and presented in the Table below.
The relationship of EI structures with structures of servant leadership models.
| EI
structure |
Page and Wong’s SL Model(2000) | Patterson’s SL Model (2003) | Russell and stone’s SL Model(2002) | Sendjaya and
Sarros’ SL Model (2002) |
Winston’s SL Model (2003) |
| Use emotion to enhance cognitive processes | Integrity | Trust
Service to the follower Altruism |
Credibility
Trust Integrity
|
Trust
equality |
Commitment to the leader
Service to the leader Altruism
|
| Express emotion and appraise | Caring for others | Trust
|
Appreciating other
Trust |
Authentic self
|
Trust
Commitment to the leader Service to the leader |
| Reflective
Regulation of emotion |
Leading
Modeling Team-building Decision-making Visioning Goal-setting Visioning
|
Service
Empowerment Trust Vision
|
Pioneering
Modeling Service Influence Persuasion Appreciation Empowerment Application of others Empowerment |
Trust
Vision Empowerment Mentoring role
|
Service
|
| Analyze and understand emotions | Authentic | Humility
Agapao
|
Internal self-change | Self-perception
Self-awareness |
Agapao
|
This recognition is very important to the making of accurate measures of servant leadership and may help trainers and consultants merge emotional intelligence elements into servant leadership (Page and Wong, 2000).
1.4 Chapter Layout
Chapter 1 contains background information to the topic of study- servant leadership. In addition to this, it discusses other existent leadership styles in an attempt to compare them to servant leadership. That is, to highlight the differences and possible similarities between them. This helped bring out the suitability and position of servant leadership as the leadership model of choice for the healthcare sector. Chapter 2 details the research methodology used in this study, including an analysis of the data. Chapter 3 contains a discussion of literature consulted by the researcher in compiling the report, mainly from scholarly work and books on servant leadership while Chapter 4 presents a discussion and analysis of the work. Finally, in Chapter 5, the researcher provides a conclusion and recommendations for future systematic reviews on the topic.
CHAPTER II
2.0 Methodology
2.1 Introduction
This chapter discusses every aspect of the systematic approach that has been undertaken in order to achieve a comprehensive review of the literature.
2.2 Systematic reviews
A systematic review requires one to follow systematic steps aimed at conducting the review to verify and present the evidence in the work. The steps include;
Table 1: Steps involved in a systematic review
| Stages | Steps |
| 1 | Determine the question to be asked |
| 2 | Devise set guidelines for the review |
| 3 | Retrieve valuable information from relevant studies |
| 4 | Assess the quality of such studies |
| 5 | Gather data using the data collection tool |
| 6 | Formulate the results of the study |
Source (Torgerson, 2003)
Hemingway and Brereton (2009) argued that reviews form an integral part of the healthcare profession and can be published together with the specific subjects addressed. In the traditional method of review, the primary data is collected, and the main points of discussion identified, with themes organised to determine the main findings. However, the traditional approach to reviews faces several challenges, such as the absence of a peer-review protocol for replicating the findings (Kirkevold 1997). In addition, traditional reviews are based on the personal beliefs and experiences of the person carrying out the review. It also has scant regard for study assessment or the selection of the studies, meaning that the review has a disadvantage in terms of the evidence it offers (Garg, Hackam & Tonelli, 2008). This requires a more comprehensive method of review, which is the systematic review method, one which is more authoritative in terms of the evidence provided (Torgerson, 2003).
According to Egger et al. (2001), a systematic review is an “explicit, formulated, reproducible, and up to date summaries of the effects of healthcare intervention (p. 2).” Furthermore, systematic reviews make use of peer-reviewed protocols that involve more than one reviewer who posses knowledge or experience in clinical practice research, without any form of bias (Hemingway & Brereton, 2009). Several studies have identified research based on particular questions, appraised the quality of the study and summarised the findings through the use of a scientific methodology (Khan et al., 2003). The implication of this is that systematic reviews are deemed more open and transparent when compared to the traditional methods of review. Other scholars (Green, 2005) have also argued that systematic reviews should assess all of the primary studies in the area, especially those related to a particular subject or clinical matter. Thus, systematic reviews have definite objectives, clear methods of carrying out the research and valid means of assessing both the results and the use of the studies that have been selected. Application of systematic reviews in establishing Evidence Based Research(EBR) has continued to gain wider recognition in the field of reviews in health care, as well as general research (Scurlock-Evans et al., 2014; Mary, Julie, & Jennifer, 2014).
2.3 Objectives
This systematic review will seek to contribute to a proper understanding of servant leadership and highlight its suitability to healthcare institutions through the discussion, analysis and comparison of existing literature. The information generated by this systematic review should be of value to leaders, managers and those charged with the management of healthcare organisations. This would aid them in improving how they use and manage their healthcare delivery, especially in regard to efficiency and effectiveness. This systematic review will seek to pursue several objectives, with the most important being:
- To examine the quality and relevance of the existing literature.
- To determine the extent of the impact of servant leadership on leaders.
- To determine the extent of servant leadership impact on followers.
2.4 Search Strategy
When searching for available literature, vigour is of paramount importance. In this research work, the most outstanding keywords were ‘servant leadership’, ‘healthcare’ and ‘leadership’. The search results were narrowed down through the use of Boolean operators in order to combine keywords with synonymous terms. The former operator served to source articles related to at least two terms. The latter provided articles that contained any two or more terms. It also helped in amassing more results when there was a small number of a search (Craig & Smyth, 2007). As Sasala (2011) observes, Boolean operators are useful for ensuring effective control and furthering of the results. Brownson (2011) notes that the sensitivity (i.e., the ability to source the relevant texts) and precision (the entire articles retrieved) of the keywords play a pivotal role in the search results.
2.4.1 Sampling Strategy
In the study of servant leadership, the researcher employed a sampling strategy to determine how the data would be extracted and synthesised. According to Khan et al. ( 2001), data extraction occurs when the relevant data is gathered from the available articles and other sources such as books and websites. The data must contain characteristics, outcomes and results as well as references. These could be personal or subject to errors or bias, and they require incisive attention in order to reap valid results (Higgins & Green, 2011).
However, data synthesis usually aims to gather and summarise the results in an organised manner that is easy for the researcher and reader to understand (Centre for Reviews and Dissemination, 2009). The research findings were therefore obtained through a literature review, in the effort to devise a summary of the results.
2.4.2 Type of Study
This research study involved a systematic review, and therefore it will be presented through evidence-based practice. Melnyk and Overholt (2005) argued that evidence-based practice (EBP) is critical in any health care study, since it helps improve the outcomes of patients’ healthcare (Peterson et al., 2014). When used in evidence-based practice, systematic reviews offer certain advantages and disadvantages. A significant advantage of systematic reviews is that the decisions made by healthcare professionals are based on evidence that can be translated into practice (Parahoo, 2006). The study findings will, therefore, be capable of being generalised, which effectively ensures that they are reliable.
Furthermore, the transparency used in the review steps for evidence-based practice support the decisions made in the gathering of information by the researcher, and this also has the advantage of demonstrating information through a comparison of all the studies used (Webb & Roe, 2007; Wong, 2012). In order to ensure the method is successful, it is important to understand the research methods to be used in the analysis of the data. This will make the systematic review more useful, as it will focus on gathering findings, rather than identifying the results already provided in respective studies.
2.4.3 Limitations
The main limitations of this study are connected with the systematic review approach (CRD’s Guideline, 2008) in addition to the fact that only one reviewer was involved. One limitation affecting this study was the use of only those papers that are written in English-language for the literature review (CRD’s guideline, 2008). This could lead to important studies conducted in other languages being neglected. In addition, the issue of personal bias may have arisen because the data extraction carried out by the researcher was completed in the absence of a peer review or an audit. A lack of peer reviews and reputable criticism regarding the texts will also weaken the research’s credibility (Torgerson, 2003). The systematic review locates diverse research articles involving various interventions, methodological approaches and designs. The issues that can arise are connected to subjectivity when selecting similar materials (CRD’s Guideline, 2008). Thus, using poor-quality studies alongside superior counterparts can lead to inaccurate estimates or a false perception of the truth.
2.4.4 Inclusion and Exclusion
The search results were variable in accuracy depending on the database that was used, because each database is designed to answer searches for particular reasons or purposes. For example, the Cochrane Library leads in resources in the context of health care (The Cochrane Library, 2014; Zhang P., et al., 2010a). Through the hierarchy of evidence and the research design used, the researcher determined which study should be utilized in this analysis (Randolph, 2009). A qualitative model was chosen because it provided information regarding the personal insights and views of individuals, including their perceptions, intentions, motivations and behaviours (Parahoo, 2006). Through the systematic review, the researcher was able to identify the articles which should be included or excluded in the study, relating to servant leadership. The inclusion criteria were used to determine the journals that were considered relevant and to minimise bias (Randolph, 2009). Therefore, the researcher devised the exclusion and inclusion criteria detailed in the table below.
Table 3: Inclusion/Exclusion Research Topics – Criteria
| Inclusion criteria | Exclusion criteria |
| Keywords selected: ‘servant leadership’, ‘healthcare’, ‘leadership’ | Articles which do not deal with the topic and question specified |
| Articles written in the English language (English being the most spoken language worldwide ,and it is the official language in UK) | Articles not written in the English language |
| Articles which address servant leadership in the healthcare | Articles concerned with servant leadership as applied to non-healthcare |
| Articles where were published between 1970 and 2014 (in order to ensure the information was up-to-date, with significant data) | Articles published before the year1970 |
2.4.5 Review Question
In this systematic review, the research question was, “What is the relationship between servant leadership and the productivity of both servant leaders and followers in organizations, especially in healthcare” A sound research question is desirable in order to ascertain the best strategy for carrying out the research. Sackett et al. (2000) propose that the research question be divided into several keywords, with an inclusion and exclusion criteria required before engaging in the process of searching for relevant literature.
2.4.6 Electronic Sources
2.5 Chapter Summary
This chapter provides an overview of the methodology used to conduct the research study, involving a systematic review approach. The steps taken in order to complete the analysis have been detailed, with the methods of the review also being identified.
CHAPTER III
3.0 Literature Review
3.1 Introduction
The purpose of this chapter is critically to appraise the literature that was used in the research (see appendix 1).It will further highlight servant leadership as exercised by both leaders and followers in the healthcare sector. This is in line with the idea that service to others within an organisation forms the basis or is the underlying concept of servant leadership in any service entity (Russell and Stone, 2002, p. 145). It will illustrate that servant leadership relies heavily on the concepts of service created by Robert Greenleaf (Greenleaf, 1970, p. 1). Accordingly, in servant leadership, the focus concerns whether the leader offers leadership inspired by servant hood. In addition, most of the work in this systematic review is not empirical in nature, but rather relies mostly on anecdotal evidence, intuition and repetitive scholarly work.
3.2 Historical Aspects of Servant Leadership
The earliest theories concerning servant leadership are significantly based on religion, as described by Boyum (2008) and Hayden (2011). For instance, early philosophies amongst the Chinese and Buddhist teachings advocated self-less service through compassion, mercy and kindness. Hinduism also supported service to God, to others or particular deities, while Western religions such as Judaism and Christianity also supported servant leadership (Hayden, 2011). Islam, which means “self-surrender to the will of God”, also implored mankind to act in the service of others through love for humanity, a charitable disposition, kindness for others, honesty ,humility, a thirst for knowledge, the desire to share knowledge and the desire to do good in the cause of promoting the glory of God (Sallie, 2009, p. 11). These religious aspects underscore the importance of service to others, rather than oneself, as the core mandate of servant leadership in any organisation (O’Brien, 2011, p.2). This section indicates that servant leadership has always emphasised service to any person within the organisation, irrespective of the position of an individual.
3.3 Modern Servant Leadership Theory
From the outset, it is important to note that servant leadership is usually based on the perception that the individual must be service-oriented in regard to those who operate within similar settings (Burke & Friedman, 2011; Greenleaf, 1970). In addition, the need to offer service must guide any activity or acts carried out by a healthcare organisation. Robert Greenleaf is believed to be the originator of the modern concept of servant leadership, having detailed the concept in his essay titled “The Servant as Leader”, published in 1970, which later developed into the book Servant Leadership: A Journey into the Nature of Legitimate Power and Greatness (Greenleaf, 1970). Although there has been a lack of empirical evidence regarding servant leadership, US scholars have tried to create and develop models of servant leadership in education (Farling, Stone & Winston, 1999). Trofino ( 1995) identified five variables for use in servant leadership – vision, credibility, trust, influence and service – and conclude that servant leadership is a form of transformational leadership (Trofino, 1995, p. 42).
Furthermore, in the US, Barbuto and Wheeler (2006) have merged the work of Greenleaf and Spears to create a concept of servant leadership by describing the 10 characteristics devised by Spears (1995), an addition to another which is not discussed by Greenleaf, namely calling . This particular model was meant for practitioners but could not be brought to an operational level in the construction of servant leadership.
Russell and Stone (2002), in their review of literature concerning servant leadership in education and business, propose nine attributes that can be attached to servant leadership, including honesty, vision, integrity, service, trust, modelling, pioneering, the appreciation of others and empowerment. They have also included other accompanying attributes, namely visibility, communication, credibility, stewardship, competence, encouragement, influence, listening, persuasion, teaching and delegation. While this argument was based on their literature review, this is not solely focused on servant leadership attributes witnessed in a healthcare institution setting. Russell and Stone’s literature can be considered relevant and helpful for healthcare professionals or leaders as the attributes could also be seen in the profession. This is so because these constructs must be exhibited by a servant at all times to the people who follow the leader.
While these servants may include employees and any other person who offers his services under a leader, the attributes are no less limited to leaders as leaders but also leaders as servants. Likewise, the characteristics presented by Russell and Stone are a part of a servant leader’s characters supporting his practical philosophy to serve first the lead by encouraging collaboration, trust, foresight, listening and ethical considerations in terms of treating patients and fellows in terms of power and empowerment. Hence, by presenting a working model for understanding servant leadership would give us a practical foundation and framework in understanding, applying, researching, and developing the servant leadership concept if used in the context of healthcare organizations in specific. Such leadership style is necessary, in this case – healthcare organization and personnel – because healthcare organizations require teamwork and strength, trust, and service towards improvement of healthcare administration and the value of care for patients.
Table 1: Servant leadership attributes
| Theme | Attributes | Accompanying Attributes |
| Servant Leadership | Vision | Communication |
| Honesty | Credibility | |
| Integrity | Competence | |
| Trust | Encouragement | |
| Service | Stewardship | |
| Modelling | Visibility | |
| Pioneering | Influence | |
| Appreciation of others | Listening | |
| Empowerment | Persuasion | |
| Teaching | ||
| Delegation |
Source: Russell and Stone (2002)
According to Stone, Russell and Patterson (2004, p. 349), servant leadership entails the leader focusing on his/her followers and ensuring that his/her attitude and behaviour towards them are congruent with the focus. To this end, in the UK, Patterson (2003, p. 1) has argued that servant leadership is a virtuous theory which involves virtues that are basically qualitative characteristics of the internal characters of a person. Virtue has, at times, been described as consisting of three elements, involving good habits, the middle ground between two extremes and the ability of a person to choose suitable options. Therefore, Patterson (2003) proposes seven constructs of virtue which work in a professional or a formal manner (Dennis & Bocarnea, 2005, p. 601). They include agapao love, humility, altruism, vision, trust, empowerment and service.
Table 2: Servant Leadership Attributes and Constructs
| Theme | Attributes | Constructs of the Attribute |
| Servant Leadership | Virtue | agapao love |
| Humility | ||
| Altruism | ||
| Vision | ||
| Trust | ||
| Empowerment | ||
| Service |
Source: Patterson (2003) and Dennis and Bocarnea (2005)
These constructs must be exhibited by a servant at all times to the people who follow him/her. These may include employees, servants and any other person who offers his/her services under a leader.
Agapao love is a concept that is difficult to understand, and Greenleaf (2002) states that the notion of love may be difficult to define, although it has infinite manifestations (Dennis & Bocarnea, 2005, p. 602). This means that any attempt at defining love merely involves a psychological preoccupation with a person. In the context of servant leadership, Patterson (2003, p. 3) argues that love plays a significant role in leadership, and includes doing the right thing at the right time and for the right reasons. Consequently, servant leaders should exhibit love for their followers and recognise their talent. Displaying love through their feelings is also important, as this aids understanding and care between servants and leaders. Servant leadership must be accompanied by unconditional love and genuine appreciation for followers, as well as general care for them (Russell, 2001, p. 76; Russell & Stone, 2002, p. 145). Patterson (2003) states that love can be exhibited by leaders in a number of ways, such as showing more care for employees than the level of care displayed by the organisation in general. There should be no pretence in regard to such love or recognition of the workers’ achievements. There should also be evidence of sympathy for an employee in relevant situations, and leaders must listen and communicate with servants when necessary.
Humility involves the lack of the overestimation of workers’ merits, in addition to valuing one’s own worth and achieved (Dennis & Bocarnea, 2005, p. 602). All leaders should respect the value of every employee by considering their achievements in perspective. Humility disregards self-glorification and relies on the advice of all organisational members. Modesty is vital, rejecting any sense of public adulation. Humility can be perceived as the most critical test of leadership, as it involves the leader granting employees the benefit of being able to act in a manner which is true to oneself.
Altruism helps in the understanding of behaviours and motives. It seeks to link the proper behaviours and motives of a person at the individual level and how it contributes to the general qualities of humans. Therefore, altruism involves being concerned about the welfare of another person, and may include personal sacrifice and personal pleasure derived from helping others. It means that one person’s acts are directed towards the benefit of others, and this is basically one of the tenets of servant leadership. Servant leadership, therefore, seeks equality in the treatment and behaviours of persons towards others, rather than for the leader’s benefit (Patterson, 2003). Furthermore, Patterson (2003) states that the focus of servant leaders should be on the person as an individual member of the organisation and the appreciation of the fact that such a person may be a worthy and valued member of the business structure. Greenleaf (1977) argues that servant leaders must be perceived to be healers who are capable of making others achieve their objectives and purposes to a level that they may not have obtained had they been left on their own.
US scholars (Farling, Stone & Winston, 1999, p. 49) have argued that servant leadership must be exercised in a visionary manner, which supports Greenleaf’s (1977) assertion that leaders must ask themselves whether the persons they serve grow according to the visions of the organisation. Therefore, the future of employees must form an important aspect of servant leadership, and such leaders should ask themselves whether the constituents of the organisation are served with their future objectives in mind. Patterson (2003) adds that the servant leader’s vision for the followers must encompass the plan he has in mind for them in the future. The implication of vision as a construct of servant leadership is that the servant leader must be able to notice the unique gifts of individual followers, which should influence future plans (Patterson, 2003).
Trust is also an important part of servant leadership in education, business and healthcare organization, fostering integrity and care for workers. According to Patterson (2003), a servant leader must, therefore, cultivate trust as an essential component of his/her leadership style, along with the teachings and theories of Greenleaf (1977). Respect and positive regard for employees allow them to become comfortable, and this fosters an environment of collaboration. Patterson (2003) adds that trust enables the leaders within a firm to unleash the power of others in order to accomplish the organisation’s goals. Melrose (1995) argues that servant leadership must involve trust, as well as accomplishing what is to be done and instilling a culture of trustworthiness. Accordingly, servant leaders must be conscious of their mistakes, encouraging teamwork and confidence in workers. This will reap the most benefits possible from workers. When trust is practised among servant leaders, employees become empowered. Consequently, such workers are better organised and more dedicated (Patterson, 2003).
Organization empowerment is an important characteristic of a servant leader and any person exercising servant leadership must use it (Buchen, 1998, p. 125; Russell & Stone 2002, p. 147). The followers must, therefore, be empowered with the best interest of those that they serve in mind is important (Patterson, 2003). Ascitedandsomenotableorganizationstheknownapplyservantleadershipprocessandservicesincludethelargestmechanicalcontractorsdollarfinancialservicesandairlinecompanyrankedand Ithoweverifhowmanyandwhatorganizationsthesectorapplyservantleadershipculturethusneedfurtherunderstandtheissueconductingthisliteraturereviewpresent
Russell and Stone (2002) argue that empowerment should incorporate active listening and valuing employees, in addition to a focus on the vital nature of teamwork. The leader encourages growth among followers, and each accepts responsibility for his/her acts or failures. To ensure that this occurs, the leader must be attentive to the needs of workers, thus equipping them with knowledge and experience.
In USA ,Farling, Stone Winston (1999, p. 51) in must empowerment of in a that is with their , should a transformational between his (Marshall & Marshall, 2011, p. 14). This requires offering service to those who need it, adopting a holistic approach, individual development and overall inclusivity during decision-making. In addition, Melrose (1995) contends that it is necessary to afford followers “elevated power” which allows them to make choices with dignity and respect for values. Expectations must also be clearly defined, along with responsibilities and aims. Also in healthcare organisation this can be achieved by encouraging people to learn and develop in their careers via self-direction (Melrose, 1995). Thus, the servant leader can relinquish control and allow followers to own their growth, progressing to embrace a fulfilling career.
Service is the most important aspect of servant leadership, because it is based not on the interests of the servant, but rather on those of others operating within the company, mainly the followers (Graham, 1991, p. 106). Farling, Stone and Winston (1999), and Russell and Stone (2002), agree that service is an integral tenet of servant leadership, and involves a choice informed by the interests of others within the organisation, rather than the interests of the individual. Greenleaf (1977) and Buchen (1998) also argue that servant leaders need to understand that they are servants with an individual mission, which affects their motivation for accepting responsibility for others. The service must provide a personal investment of time and care for other persons or employees. Thus, service can become more valuable and efficient due to the acknowledgement of each an employee’s uniqueness, thus cultivating their creativity. Smith, Montagno and Kuzmenko (2004, p. 104) have supported this by arguing that a servant leader must serve as a role model, both in terms of behaviour and character, by serving others through a consideration of such person’s interests, rather than their own interests. Melrose (1995) states that, when this is carried out, service is likely to beget more service, and therefore the whole organisation will operate along the lines of servant leadership, which is required between leaders and their followers.
The above attributes of servant leadership are important for a healthcare organisation, and a servant leader must endeavour to teach the followers with the aim of developing them through the values and personal beliefs that form the core of servant leadership. Since the theory of servant leadership is the central point of discussion in this systematic review, its attributes will be adopted. Greenleaf conceptualised 11 characteristics of servant leadership that have been renamed and expanded by different scholars. These include:
Calling– This relates to an inner sense of vocation in leaders, which is portrayed in their actions, thus encouraging workers in regard to the intentions of the leader. The feeling of calling must be natural and genuine in servant leaders. Listening-Leaders need to be very attentive to the ideas of their employees. Listening can be learned. Empathy-This concerns a servant leader’s capability of gaining the workers’ confidence, accomplishing this by understanding their problems. Healing- pertains to the leader’s skill in allowing space for followers to relax, express their frustrations and guide them in distressful situations. This provides a unique and valuable support system. Awareness– Leaders must be aware of all occurrences, and they must not be taken advantage of by anyone in the organisation.
Persuasion is connected with the leader’s ability to convince others to complete certain tasks via persuasion, rather than performing tasks by order. Conceptualisation -involves how well a leader can measure performance. Leaders must engage with their creative side to cultivate a positive working atmosphere. Foresight– Leaders must be able to anticipate effectively via an understanding of the current situation. Stewardship- Leaders must provide inspiration and guidance. This is unique to servant leadership. Growth-Servant leaders must be dedicated to the growth of employees, recognising that every individual possesses certain unique characteristics. Building community- Leaders should view the company as a family, and should encourage these feelings among followers. This can serve to motivate followers in such a way that they become a complete unit.
Greenleaf’s list indicates that a servant leader must possess natural qualities such as empathy, calling, healing and stewardship, which are difficult to learn. However, qualities such as building community, awareness, listening, conceptualisation, persuasion, foresight and growth can be mastered through a constant learning process. In any case, a strong desire to become a servant leader can help people to practice these natural traits. While the 11 attributes are quite different from the previous themes presented in earlier tables, they are more or less related to each other. However, there are differences in regard to the attributes that directly relate to the human emotions exhibited by healthcare providers/leaders to the patients and their team, which are not easily noted in the leaders of corporate organisations. The above elements would help the servant leaders to address all spheres of followers and enable them to achieve individual transformation in less time. The figure below illustrates how servant leadership delivers individual employee transformation in a more efficient manner.
Figure 2: Efficiency of individual employee transformation via servant leadership
3.4 Measures of Servant Leadership
Due to the difficulty involved in the construction of servant leadership, different US and UK scholars have worked together to devise universally acceptable measures that can be applied to this topic. This has been created through models that assign different attributes to the concept of servant leadership and measure their applicability in an organisational context. For instance, in the US, Laub (1999) has created what is referred to as the Organizational Leadership Assessment (OLA), using six sub-scales that characterise servant leadership in any organisation (Laub, 1999, pp. 4-7). Through the use and development of 60 items, the six sub-scales were measured in order to determine the job satisfaction of members of the organisation. The alphas in this study ranged from 0.90 to 0.93, and no divergent or convergent-divergent validity was reported, nor was a confirmatory factor analysis conducted. Only a later version was available for the study by Laub (1999).
Similarly, Page and Wong (2000) used twelve dimensions of servant leadership for their study (Wong & Page, 2003, p. 3). These researchers created a rater-only Servant Leadership Profile (SLP) that contained twenty-three items to be measured, while the alphas reported ranged from 0.89 to 0.97. They did not report any convergent or divergent validity, and failed to carry out a confirmatory factor analysis. Furthermore, Dennis and Winston (2003) conducted an exploratory factor analysis of the SLP data, as used by Page and Wong (2000), and reported three dimensions: vision, service and empowerment. According to Dennis and Winston (2003), the servant leader must be capable of empowering the healthcare within the organisation by directing their actions in line with the visions that they have set. Through this, they can then achieve the aims and objectives of the organisation.
Ehrhart (2004, p. 61), meanwhile, has developed a fourteen-item one-dimensional model that has hypothesised procedural justice. This was designed to mediate between the behaviours of leadership (servant leadership), namely the unit-level organisational behaviour of citizens. This was carried out through the use of seven subscales: forming relationships with subordinates, empowering subordinates, helping subordinates to grow and succeed, behaving ethically, possessing conceptual skills, prioritising subordinates and creating value for those outside the organisation (Ehrhart, 2004, p. 62). In addition, Dennis and Bocarnea (2005) created the Servant Leadership Assessment Instrument (SLAI), which adopted the model proposed by Patterson (Winston, 2003, p.1). This was developed through the use of literature concerning servant leadership, an expert panel and an exploratory factor analysis. It had alphas ranging from 0.77 to 0.94 and did not involve a confirmatory factor analysis.
More recently, Barbuto and Wheeler (2006) have spearheaded the construction and measurement of servant leadership through exploratory factor analysis, confirmatory factor analysis, substantive criterion validity, convergent validity and divergent validity, as well as predictive validity. This study formed the basis for other future studies carried out in the measurement and construction of servant leadership (Sendjaya, Sarros & Santora, 2008; Barbuto and Wheeler, 2006). Barbuto and Wheeler (2006) have identified five dimensions that can be attributed to servant leadership, which include emotional healing, altruistic calling wisdom, persuasive mapping and organisational stewardship. Altruisticcallingaccordingdefinitionrefersthefundamentalconsciouschoiceserveotherindividualsandpositivelyinfluencetheprovisionservice
Altruistic calling, according to Greenleaf’s (1977) definition, refers to the fundamental, conscious choice to serve other individuals and positively influence them through the provision of service (Barbuto & Wheeler, 2006, p. 300). Therefore, servant leaders must embrace service and personal sacrifices in order to serve the followers within the organisation. Conversely, emotional healing refers to the ability to recognise the time and manner of facilitating the healing process within the organisation, especially recovery from trauma or any form of suffering. This calls for the servant leader to be empathetic and sensitive to his/her followers through the creation of a safer environment which enables them to discuss their problems and concerns freely. Wisdom is described as the ability to notice indications from the environment and understand their implications (Barbuto & Wheeler, 2006, p. 319). The servant leader must, therefore, be observant and anticipate any complexity that may affect the organisation through his/her wisdom and knowledge.
Persuasive mapping refers to the ability of the servant leader to make use of sound reasoning and mental models to cause other persons within the organisation think in a lateral manner (Barbuto & Wheeler, 2006, p. 319). This makes the servant leader able to articulate issues easily and enjoy possibilities that may affect the organisation. Furthermore, the leader can support the followers within the organisation so that they are more productive in the achievement of the goals and missions of the organisation. Organisational stewardship refers to the level at which the servant leader sets about making a positive contribution to the community (Barbuto & Wheeler, 2006, p. 319). Therefore, the servant leader must embrace a concept of social responsibility which aims at positively impacting on the lives of all individuals within the organisation. This calls for the servant to initiate measures for benefiting the community through community outreach programmes, or what has been referred to as corporate social responsibility.
Sendjaya, Sarros and Santora (2008) developed the Servant Leadership Behavior Scale (SLBS). This model was developed through the use of past servant leadership measures, scholarly work and interviews carried out with 15 experts, who offered their opinions on servant leadership. They devised six dimensions including voluntary subordination, authentic self, covenantal relationships, responsible morality, transcendent spirituality and transforming influence (Sendjaya, Sarros & Santora, 2008). This model did not involve any convergent or divergent validity data, but did incorporate confirmatory factor analysis. Similarly, in the Nether-lands, van Dierendonck and Nuijten (2010) created the Servant Leadership Survey (SLS), involving both exploratory and confirmatory factor analysis. From this, eight characteristics of servant leadership were derived, including accountability, standing back, authenticity, humility, courage, interpersonal acceptance and empowerment, stewardship.
3.5 Conceptual Framework for Servant Leadership
As has been noted, servant leadership must incorporate empowerment, service ethic and participatory management amongst other ideals of management. This implies an increased emphasis on offering service to others and the promotion of the sense of community as well as the sharing of roles in the making of decisions that affect an organization (McGee-Cooper & Looper, 2001, p. 3). In this section, a conceptual framework for the assessment of servant leadership will be developed to help in further discussions.
An analysis of the literature on servant leadership in this research study has indicated that no empirical measures capture the conceptualization of servant leadership as proposed by Greenleaf. This has occurred because most of the available studies failed to focus on the followers but the characters, behaviors, attributes and beliefs of the servant leader. However, there are now numerous studies that have focused on measuring servant leadership and showing how it should be exercised in an organization. For instance, Laub (1999) has used job satisfaction as an integral tenet of servant leadership in any organization through the Servant Organizational Leadership Assessment (SOLA) model. Ehrhart (2004) has used the behavior of the organization in his work while Barbuto and Wheeler (2006) made use of employee satisfaction, effectiveness of the organization and extra work as measures of servant leadership. The above measurements are in contrast with the work of Greenleaf that did not limit servant leadership to the organization alone but involved the ability to transfer attributes from the individual to others. It is important to note that the outcomes proposed by Greenleaf were personal in nature and did not focus on the organization as the person had to first to appreciate the positive dimensions that make a servant leader before the organization could be deemed successful.
Servant leadership borrows from several disciplines including religion, management, as well as psychological concepts, and this may at times make it difficult to develop a conceptual framework. Most authorities and scholarly work suggest that in order to learn and appreciate servant leadership, it is important to explore self-discovery and personal transformation of the servant leader. A servant leader has been described as a type of leader whose major role is to lead the followers through investing in their growth and development as well as their well-being in order to execute the allocated tasks and goals of the organization. Therefore, the major role of the servant leader is to serve other people for the common good through giving up of self-interest for the development of others. Further, servant leaders will only be distinguished from others by the exercise of responsibilities and how decisions are made through inclusivity of all members within the organization.
In today’s organizations, effectiveness and productivity can only be ensured through proper management of healthcare as well as the processes within the organization. These systems and the people can in turn only be effective if the people charged with leading them are useful. Servant leadership, therefore, becomes relevant and integral to such an organization as it ensures that it invests in highly motivated human resources who are empowered to do their best to achieve its missions and goals. As a concept, servant leadership requires a fundamental commitment by the servant leader to serve the followers through humility and integrity with service as the underpinning ideal. The servant leader must be people-oriented as he needs to relate to the others by showing an interest in the development of their potentials for the betterment of the organization. In addition, the servant leader must be task oriented as it describes how the leader executes his tasks especially when it comes to decision-making and implementation of resolutions. Finally, there is the process-orientation which describes how the servant leader can impact on the processes of the organization such as the building of teams, their modeling and how decisions are made. In this systematic review, the concept of servant leadership was buttressed on people and task orientation as the major concepts as well as process-orientation. This underscores the desire by the servant leader of achieving the objectives of the institution through a community spirit, perceiving work as a partnership of service and exercise of prudent management of resources within the organization.
In critiquing the measurements that have been given and attributed to different scholars, it is imperative that most of them have not followed the original articulation of servant leadership as was constructed by Greenleaf. While Greenleaf argued that it was possible to see the evidence concerning servant leadership, these scholars have created several dimensions of characterizing a servant leader. These include conflicting views and insights on the behaviors, attributes, beliefs, attitudes and values of the servant leader, which lack empirical support (Washington, Sutton & Feild, 2006, p. 700). Also, the fact that these studies fail to evaluate Greenleaf’s postulated or personal outcomes, they look at results that can only be attributed to the organization and not the individual.
In a healthcare organization, the leaders through servant leadership should be capable of transforming the culture of the staff within the organization (Amadeo, 2009, p. 15). The servant leader must, therefore, be capable of creating an environment that ethically cares for the followers, as well as the constituents of the organization (Huber, 2013, p. 2). Howatson-Jones (2004, p. 1) of a would be of , amongst within to them. They, therefore, propose four fundamental characteristics that will determine what makes servant leadership. These include the integration of spiritual care in the provision of health care to the constituents served by the hospital as part of service orientation which relates to the aspect of healing. . Servant leadership also ensures that the followers are satisfied with their job basically through changing of their attitudes toward supervisor support, guaranteeing autonomy and provision of a conducive environment for the follower (Garber et al., 2009, p. 331).
3.6 Critical Commentary
Theories such as the Robert Greenleaf theory on servant leadership, suggest that a leader should offer service unconditionally, expecting nothing in return (Smith, 2005; Sendjaya & Sarros, 2002) According to Greenleaf’s theory, the greatest leaders are first seen as servants (Smith, 2005 p. 3). This could be one of the reasons for which religions have become so powerful, penetrating to all corners of the world. They emphasise the importance of service to others, rather than to oneself. Smith (2005) discussed the tenets of Greenleaf’s servant leadership theory and portrayed a servant leader as someone who humbles him/herself to the extent of working together with the other employees who are under him/her in the organisation, offers services to others, holds the idea that man exists for work and work for man, encourages team work and shares his power with followers by involving them in decision making. In that case, a servant leader is characterized by having empathy, good listening skills, persuasion, emotional healing, altruistic calling, foresight, stewardship, ability to conceptualize solutions, having a commitment to the development of followers and community building skills (Smith, 2005 p. 5& 6; Burbuto & Wheeler, 2006).
I found that, in organisations led by servant leaders, the leaders focus on an inner, rather than an outer, perspective in problem and conflict solving by trying to identify with the problem or challenge and taking a spiritual approach as explained by (Miller, 2004). This is because the leader is also part of the employees’ team, making him/her fully aware of the challenges that staff members face (Wagner-Marsh & Conley, 1999). The leader allows the problems to surface and finds the source of the problem, instead of threatening the employees and silencing them. In addition to this type of leader being service-oriented, I think that the desire to offer service to others must guide all activities in a healthcare organisation. Trofino (1995) listed some qualities possessed by servant leaders, which include ‘service, vision, trust, credibility and influence’. It is usually difficult to have a leader with all of these qualities; only good leaders will possess the full combination. Most leaders possess one or two of these qualities but lack the others, disqualifying him/her from being a servant leader. The most conspicuous feature in all of these variables is service which brings about influence not only on the employees, but also on the whole organisation, including the realisation of its vision and goal achievement. Those traits can be summarised as the attributes of a caring leader, as Koloroutis (2004) has explained.
In my opinion, servant leadership does not change, whether in relation to education, healthcare or business (Servant leadership in healthcare, education and business is discussed in detail in chapter IV). This opinion is supported by a number of research publications. For example, Tureman (2013) noted that while competencies and proficiencies from one field to another, servant leaders will always share common traits or attributes. Russell and Stone (2002) have proposed the characteristics of servant leaders in the areas of business and education. These characteristics revolve around service, trust and integrity. The same attributes have been found from studies servant leadership in healthcare organisations. This is exemplified by Stanley’s (2006) study on congruent leadership in healthcare.
Congruent Leadership Style
The congruent leader’s style, as proposed by Stanley (2006) clearly asserts my position that servant leadership does not change, whether in relation to education, healthcare or business. Competencies and proficiencies may vary from one field to another but servant leaders will always share common traits or attributes. Congruent leadership refers to servant leadership in the nursing context. A clinical leader is defined as a person with clinical expertise in an area of specialization and who enables other nurses deliver quality services to patients by using interpersonal skills (Stanley, 2006). These leaders are approachable, effective communicators who act as role models who match their beliefs and values to nursing practise. They act as role models who are visible and inspirational. They lead by setting examples and helping others become better. They do not necessarily hold managerial positions but are emulated for being outstanding in their work. These therefore are servant leaders who lead by example, but in a healthcare setting.
I think that the theories on servant leadership are very applicable even today, especially in healthcare organisations, because the nature of the work involved in such organisations cannot be comprehensively defined and requires an individual with a special calling. Most important is a servant leader possessing all of the qualities mentioned above, to lead the people through service (Barr & Dowding, 2012). These qualities are not only exhibited by the leaders in such organisations alone, but also by all of the staff members operating in those organisations. This is why the leader must serve first, and then lead. In a healthcare organisation where there is no teamwork or a lack of trust among the members of the leadership team, chances of failure increase tremendously (Baker et al., 2006).
The Role of Servant Leadership in Employee Motivation
Majority of healthcare workers who do not feel satisfied in their workplace often quit their jobs mostly due to the stressful environment they undergo. However, this can be decreased by addressing the factors that make the nurses uncomfortable in their workplaces. The hierarchy of inborn needs is a theory that was developed by Abraham Maslow. The theory conceptualizes human needs as a pyramid with five levels (Rogers and Maslow, 2008). The levels, in ascending order, range from physiological needs (at the bottom), safety needs, belonging, esteem, and self-actualization at the top. Maslow argued that human beings are innately motivated towards self-development and psychological growth. He further argued that human beings work to meet the needs at the lower levels before they can get motivation to pursue higher level needs.
This theory is very applicable in the nursing career in the sense that when the nurses feel that the job does not help them meet their physiological needs, they become de-motivated (Chassin & Loeb, 2011). Such employees are not likely to pursue higher level progress in their careers. In an attempt to reach higher levels of Maslow’s pyramid, employees quit working environments that do not support their growth and start searching for new ones that favor their progress. Therefore, dissatisfaction is a huge contributor to nursing turnover and an important indicator of the working environment’s quality.
To reduce voluntary turnover, healthcare managers should consider improving the work environment by promoting good communication, teamwork and nurse empowerment, e.g. by involving the nurses in decision-making. Stress in the nursing work environment is caused by a number of factors such as tight work schedules, new technology, unpredictable workflow and workload, patient acuity and poor nurse-physician interactions (Bowles and Candela, 2005). A healthy working environment of nurses is characterized by a nursing staff that is able collaborate with other members from other disciplines and is able to take control over the issues related to the nursing career (Hughes, 2008). A healthy nursing working environment produces a stable and satisfied workforce and favorable clinical outcomes.
While working in the healthcare sector enables healthcare workers secure physiological needs e.g. basic needs like food and shelter, these professionals desire to achieve more and reach higher levels of the Maslow’s pyramid. Servant leadership is important in helping healthcare workers attain these levels because servant leaders enable others deliver quality services to patients by using interpersonal skills, motivating them, building capacity and setting examples to be emulated, etc. Servant leadership is a cherishing, appreciative style of leadership that leads to higher job satisfaction among employees (followers and leaders) (Hayhurst, Saylor & Stuenkel, 2005). Servant leadership, for example, encourages love for the people whom one is serving, for those whom one is leading and for the job itself. The opposite of love is indifference, which, if present amongst people in an organisation, affects the operation of the whole organisation negatively. Love must be present in a servant leader; otherwise, one becomes a dictator, and views other employees as mere servants in the organisation.
In an organization where there is love among employees, teamwork is bound to be strengthened. This, in turn, increases the employees’ feeling that they are an integral part of the organisation. Thus, they work very hard to increase their productivity. This is also true with effective communication, which is vital to any organisation, whether in healthcare or in any other type of organisation (Bass, 1990; Hackman and Jonnson, 1996; Nix, 1997). Servant leadership promotes effective communication and better learning by followers from the leaders, as well as better communication of challenges and their solutions. In fact, the effectiveness of servant leadership in a health organisation depends on the level of interdependence and communication in the organisation (Fisher & Riley, 2005). This enhanced communication, which allows a better flow of information, helps healthcare workers develop their skills more quickly and reach self actualization levels faster.
In my opinion, leadership directly affects the employees’ productivity in any organisation. A poor relationship between the leader and the followers leads to low job satisfaction and high employee turnover, thus lowering the level of productivity and employee development in the organisation (Persily, 2013). Conversely, if the bond between a leader and followers is high, he/she is always informed of events in the organisation and the feelings of the employees. Servant leadership, therefore, provides good work conditions, hence, ensures that employees are committed and motivated. This reduces employee turnover and leads to increased productivity in the organisation.
CHAPTER IV
4.0 Homework help – Discussion
4.1 Introduction
This chapter will discuss the main conclusions derived from the studies explored on servant leadership across a broad array of organizations, and then offer particular attention to the organizations operating in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia’s healthcare sectorThis is followed by a discussion of the implications of servant leadership. Greenleaf (1969) proposed that the “great leader is seen as servant first.” He spent five decades challenging organizations in the fields of healthcare, education, and business to take up a servant leadership style because he believed this would fundamentally change society for the better. He conjectured that because servant leaders take care of their followers’ greatest needs first, followers “become healthier, wiser, freer, more autonomous and more likely to in turn become servants.”
4.2 Homework help – Discussion
4.2.1 Servant leadership in healthcare organization
In this systematic review, it was indicated that altruistic calling was the most important factor in influencing the servant leadership. It shows the deep desire to offer service to others first before offering the service to self as the distinguishing feature of a servant leader (Senge, 1995, p. 217; Blanchard & Hodges, 2002, p. 2). Therefore, the servant must put the growth of the follower first before considering his growth as a true servant is seen by how he serves the followers. The literatures consulted included Barbuto and Wheeler (2006); the authors did the study with the aim of filling the information gaps identified by scholars like Bass (2002). The study by Bass arrived at the conclusion that servant leadership is mainly an elusive construct, where there is a broad reaching lack of consensus from its proponents and supporters. In furthering the concept and shedding further light on servant leadership, Barbuto and Wheeler (2006) highlighted and established the scope of servant leadership. The conclusions of the study included that it spans the wisdom to offer emotional wellness; it draws mainly from the unselfish desire to serve, the capacity to persuade, and stewardship for the organization (Barbuto and Wheeler, 2006).
In this systematic review, it was shown that it was possible to predict the outcomes of health, wisdom and freedom-autonomy through altruistic calling in the leader. The review of Greenleaf (1977) showed that the importance of servant leadership in mentoring personal growth since follower grow when good leadership is exercised, especially in terms of wisdom, freedom and autonomy. This in turn may inspire the emulation of the servant leader by the followers who will execute their roles in the desired manner and style. As a leader, it is, therefore, important to put the interest of the followers first before your own so that the follower can grow into a healthy staff (Baron, 2010, p. 2). By adopting the values of a servant leader, a variety of values and abilities are developed, including the wisdom needed to increase the emotional wellness of followers (staff). Further, the leader employs the unselfish desire to serve the followers, the ability to persuade, and the capacity to become a good steward for the organization (Barbuto and Wheeler, 2006). The value-areas identified earlier give the leader the capacity to cultivate a positive mental outlook at all times, leading to few or no incidences of getting sick, due to the benefits of operating in a healthy and conducive work environment.
The health cultivated among the staff, following the leader’s role as an emotional leader, becomes manifest through the attainment of positive outcomes in the physical, psychological and emotional health of the followers (Barbuto and Wheeler, 2006). For example, by resolve work conflicts successfully, and going ahead to foster emotional healing among staffs, the leader creates a work environment where there is not resentment; levels of cooperative work and offering support foster all the aspects of health. The ability of the leader to lead and provide support without selfishness enables them to give the staffs, sufficient emotional support; the phenomenon was reported by Morse et al. (2012) as likely to reduce or prevent burnout levels among staffs. Without offering support from an altruistic point of view, the followers vulnerability to illnesses and poor wellbeing increases, which would compromise the quality of services delivered to the organization. Therefore, it is imperative that the servant leader and the followers offer a mutually beneficial relationship based on the altruistic calling, in order to guarantee the health of the healthcare sector and enhancement of organizational productivity. In the context of the Middle East, leadership development is more preferred, as opposed to the development of leaders, due to the emphasis channeled towards the development of abilities, skillfulness, talent and know-how needed to occupy leadership positions effectively. The focus of leadership develop programs include interpersonal excellence and effectiveness, which directs attention to the importance of networked relationships and the support accorded (Day, 2001).
In particular, the study by Al-Dabbagh (2009) pointed out that the context of leadership in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia makes servant leadership a highly efficient and preferred model. Drawing from the Middle East and the Kingdom of Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia context in particular, the findings of this observation were consistent with the systematic review of the healthcare sector in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia. The similarity highlighted included that servant leadership was at the core of the areas that are effectively managed and administrated. In a similar way, Reynolds (2011, pp. 155) pointed out that little studies have been done to reflect the effect and influence of servant leadership on women, so as to demonstrate that servant leadership is a gender-integrative outlook to leadership (Reynolds, N.D, pp. 14). One strategy that can be used to integrate women and explore the influence of servant leadership includes the adoption of gender-integrative education at the workplace.
Altruistic calling was also seen and related to play a part in the wisdom outcome of the followers. The servant leader must at all times aim at helping the followers to become more productive and successful in the executing of the objectives, missions and vision of the organization. Wisdom, therefore, comes in the facilitation of such growth as the servant must be savvy, intuitive, and aware and at times need to use his sixth sense (the ability to think creatively about issues of leadership, especially where there are no express directives on the course to take) in order to develop the healthcare within the organization (Dierendonck and Nuijten, 2011). In some cases, it is necessary for the servant leader to give the staffs advice and warnings, regarding taking some actions or making omissions, in order to accord them with the know-how on the ways of carrying out of the duties of the organization (Avolio and Locke, 2002). This role of the servant leader highlights the fact that the followers of the healthcare organization gain new knowledge and wisdom, from his experience, guidance, knowledge and mentorship (Damen, Knippenberg and Knippenberg, 2008). More precisely, the servant leader translates their experiences, knowledge and wisdom to the organizational context, towards the realization of the mandate and the ideals of the organization. The outcome of knowledge transmission, due to the altruistic nature of the servant leader, offers the staffs, opportunities for the development and the advancement of the healthcare, by extension (Alhari and Yusoff, 2012, pp. 59).
Altruistic calling as shown by the service offered by the servant leader was consistent with freedom-autonomy demonstrated by the followers. A leader who assists the followers, as opposed to one who leads authoritatively, relates more smoothly with the followers (Dennis and Bocarnea, 2005). The role of the servant leader was fully explored by Duty (2014), where it was highlighted that the leading role is more of rendering service than leading. The services rendered by the leader include those of assisting the followers to, in a variety of way, including awareness, foresight and personal development .The adoption of servant leadership also entails the elimination of the structures that may hinder the efficient working of the followers, for the benefit of the organization. For example, in order to cultivate the leadership abilities of the staffs, the servant leader, often needs to trust the followers ability to make decisions and act on their own. Doing that allows the staffs to utilize their creativity in executing their duties to the organization (Druskat and Pescosolido, 2002). The organization benefits from the creativity of the highly engaged staffs; their input increases due to working autonomously without the control of the leader, like the case is reported in Prince Sultan Hospital in Riyadh ,Kingdom of Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia (Alhari and Yusoff, 2012, pp. 59).
The systematic review also found out that emotional healing in the leader was related to the follower in a servant leadership relationship. The emotional healing is defined as the willingness and capacity of the servant leader to have a closer level of interaction with the follower especially to a personal level (Euwema, Wendt and Emmerik, 2007). Therefore, any follower who may be undergoing some form of pain, trauma, suffering or has been affected in some manner should benefit from a personal intervention and care other than the usual formal relationship at the workplace from the servant leader (Ahmed, 2009, pp. 153). The servant leader must therefore connect with the follower who is experiencing some problem or suffering and assist them to heal emotionally.
Greenleaf (2002) also postulated that wisdom must characterize any form of servant leadership as the leader must be knowledgeable and wise in how he runs the organization. This requires that the servant leader is aware of what is transpiring around him and within the organization in order to exercise foresight so that he does not get surprised by any change. A wise servant leader will be aware or prepared for any changes that may occur within the environment of the organization so that the followers are ready to act and ready to act whenever the change or disruption occurs (Euwema, Wendt and Emmerik, 2007). In this systematic review, it was shown that wisdom was a reliable predictor of service orientation amongst the followers. Therefore, the followers work for the organization knowing that it must also play a role in giving back to the community that it serves which may be through outreach programs, charities or corporate social responsibility acts (Rowe, 2003, p. 25). The implication of this is that where there is a servant leadership relationship, the organization must endeavor to give back and be beneficial to all the stakeholders served by the organization.
The above observation is consistent with the finding that followers within the different organization think as a group that it is the duty and responsibility of the organization to offer service not just to self but also within the community and the stakeholders it serves (Barbuto and Wheeler, 2006). The justification for the aforementioned observation is the fact that the model proposed by the theory of scholars posits that the followers in a servant leadership relationship or setting can only become servants if they think that the organization is service oriented to other stakeholders (Smith, 2005, pp. 6). When compared with altruistic calling as the basis of servant leadership, it is found that service orientation varies but will be supported by all followers acting within a group within the organization. This observation confirms the almost similarity between altruistic calling and service orientation as the basis of servant leadership (Smith, 2005, pp. 7).
This systematic review also attempted to evaluate persuasive mapping as one of the ingredients of servant leadership. Compelling mapping as already discussed usually involves the elements of alignment with corporate strategy of the organization, awareness of organizational politics and knowledge of how things work within the organization amongst other elements on servant leadership dimensions (Day, 2001, pp. 581). This underscores the fact that it is majorly a managerial issue that has little to do with the personal outcomes of the followers and therefore they will have little understanding of how it supports servant leadership (Bass, 2000, pp. 19). The argument here is that the followers assume that the leader while exercising persuasive mapping is fulfilling his role within the organization and not going beyond service as required of servant leadership. In Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia, any communication by the leader, for instance on hospital corporate strategy was traditionally assumed by the follower, as an opportunity to carry out the instructions, rather than exchanging with the leader (Dorgham and Al.Mahmoud, 2013). Therefore, the researchers in this systematic review by assuming that a leader carrying out the elements of persuasive mapping was only carrying out his mandate showed less belief in such acts as servant leadership.
This review also confirmed that there is a relationship between servant leadership especially the effects seen amongst the followers in terms of their health, wisdom, and freedom-autonomy as well as service orientation. This systematic review confirmed the position by Greenleaf that health and wisdom have the most significant relationship between servant leadership and the productivity of leaders and followers (Smith, 2005, p. 4). The health in servant leadership was described as the physical, psychological and emotional well-being of an individual and servant leadership creates a positive and healthy environment at the workplace. Wisdom was necessary in servant leadership as it helped in the follower being aware of the situation and perception of the directions that the organization is adopting. This would in turn make them more knowledgeable to make better decisions for positive outcomes amongst the followers of any organization. Therefore, servant leaders who showed that they possess wisdom passed them onto their followers for proper execution of the mandate of the organization (Greenleaf, 2002, pp. 75).
The review also showed that freedom-autonomy was predicted by the servant leadership dimensions in a positive manner especially when the organization is arranged in a hierarchical manner. An employee or follower with some level of freedom or autonomy is therefore capable of making her decisions in a competent manner and with confidence for reliable and efficient carrying out of the mandate of the organization. Therefore, any organization that desires to derive maximum benefits from the employees must give the employees a level of freedom or autonomy. This can be achieved by trusting the employee to do what is desired of him and know their exercise and limits of authority especially the time and manner of its exercise.
The systematic review also showed that servant leadership requires what is known as service orientation in that both the servant leader and the followers must endeavor to become servants themselves. In order for a person to serve, it is important that the follower has an objective to act as reciprocation to the fact that the leader of the organization is leading through servant leadership. This particular outcome confirmed the theory that servant leadership required that the followers adopt the servant hood as exercised by their leader for mutual benefits of the healthcare within the organization as well as the organization itself. Servant leadership is therefore premised on the fact that leadership is about service by both the served and those that are carrying out the service as premised on altruistic calling and service orientation themes (Spears & Lawrence, 2002, p. 4). In conclusion, this systematic review shows that the servant leadership is workable in different types of organizations context both at individual and group level with altruistic calling being the most important and relevant for servant leadership as it underscores service. Therefore, any form of servant leadership must start from altruistic calling in order to make the followers be service oriented.
4.2.2 Servant Leadership in Business
Many organizations have successfully implemented servant leadership. West Jet Airlines Ltd., based in Calgary, Alberta, has done so, achieving success in a demanding market (Davis, 2004). For Page and Wong (2004), the success of servant leadership has been emphasized via conferences, publications and various courses. Most of Fortune Magazine’s top companies have implemented certain features of servant leadership. Its recent proliferation has arisen from the fact that it is part of a larger shift away from command and control leadership. It has also been heralded as counteracting corporate scandals, as management teams and leaders are held responsible (Page & Wong, 2003). Thus, servant leadership has developed to become a guiding philosophy in several companies. These include the Toro Company, the Men’s Warehouse, Southwest Airlines, Synovus Financial Corporation, Service Master Company and TD Industries (Spears, 2004).
4.2.3 Servant Leadership in Education
Colleges and universities must provide leadership preparation for those individuals who possess the appropriate qualities. These people should be taught how to identify opportunities to help their communities. Specifically, there should be a concentration on values amongst colleges and universities. Students must be enabled to make the right choices in life. Spears (2004) observe that servant leadership is adopted in formal and informal education, in addition to various training programs. Several colleges and universities have provided direction and management courses which rely on the servant leadership approach, in addition to corporate training programs which also depend on this philosophy.
4.3 Implications
This systematic review asserted service as the core aspect of servant leadership. Even though servant leadership has been discussed, this systematic review has endeavored to go into the root elements of servant leadership as required of a servant leader. This has been carried out through the relationship between servant leadership and the productivity of both servant leaders and follower .This confirms that servant leadership ensures that the followers have a positive experience and they in turn offer better services to the organization. Servant leadership has therefore been proven in this systematic review as existent and a desirable concept that should be put to use by all organizations in order to derive maximum benefits from their healthcare (Ahmed, 2009). This has been made possible by the study as it has shown the effects and results of servant leadership in healthcare organization.
An important implication of this study is that it has given impetus to scholars and organizations a valid basis for exercise of servant leadership as a noble type of leadership for their entities and organizations. It is more important and relevant for businesses as they are made aware of the manner they can use to maximize the potential of their human resources. An example of such a measure would be ensuring the sound health of their employees in order to make them more productive. In addition, organizations can operationalize wisdom in servant leadership to make the employees or the staff more aware, savvy and possess the ability to adapt to changes and increase their experience (Dorgham and Al.Mahmoud, 2013, pp. 75). It can also enhance the freedom and autonomy of health care within businesses and organizations so that they are empowered to act even without being directed to do so by their leaders. This may be necessary for such a business in terms of continuity as the workers or the staff within the organization can act as long as they understand the problems and can proffer solution to the problem (Anonymous, 2014, pp. 3). In conclusion, it can be stated that the evaluation of servant leadership in this systematic review has made it possible to understand the dynamics of servant leadership as practiced by servant leaders towards their followers and put it into practice.
CHAPTER V
5.0 Conclusion and Recommendations
5.1 Conclusion
This systematic review has shown that servant leadership in different type of organizations especially in healthcare sector confirmed the theorized by (Anderson,2005 Garber et al., 2009) that servant leadership has therefore been proven as existent and a desirable concept that should be put to use by all organizations in order to derive maximum benefits from their human resources. Healthcare is in most instances not-for-profit organizations that operate in fair environments to provide the much-needed health care services. They also attract staff including servant leaders and followers who work with the aim of growing, build consensus in differing atmospheres as well as provide essential health care services to the community (Smith, Montagno & Kuzmenko, 2004, p. 89). Therefore such opportunities offer the best way in which servant leadership can be put into practice in the healthcare sector. Even though, this systematic review tried to link servant leadership and the productivity of both servant leaders and followers in healthcare organizations to makes this systematic review very valuable.
The servant leadership as seen in literature review confirmed that the servant leadership positively influences the productivity of both servant leaders and the followers in healthcare organization. The environment that is created by the servant leader must be conducive for the carrying out of their duties so that they feel healthier, wiser and more inclined to be servants themselves.
Author’s hospital in Riyadh, Kingdom of Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia, it has been shown that in order to have productive followers, there must be a satisfaction on the part of the followers of healthcare organization (Neill & Saunders, 2008, p. 396). The review has shown that there is a positive correlation between satisfied employees and servant leadership within the organization especially those that provide health care services .It is important that managers exercise leadership that emphasizes service amongst the followers in order to guarantee their retention in the service of the hospital or health facility( Anthony et al., 2005, p. 145).The strong positive correlations with the variables show that health care workers will only be satisfied if they feel that the leader actively involves him in servant leadership .This is because servant leadership mediates between the values and tasks of the follower and how the individual is inclined to offer services. In conclusion, the systematic review has reaffirmed the notion that a servant leader must care for the followers in order to positively influence the whole organization to be service oriented (Spears & Lawrence, 2002)
Further, it was shown that servant leadership in author’s hospital must adopt a humanistic and ethical approach in order that the followers are satisfied with their jobs (Jenkins & Stewart, 2010, p.46). This was indicated by staff that saw servant leadership as requiring nurturing, encouragement and ethical behaviors as exercised by the servant leader towards his followers.
The systematic review also gave a positive correlation between the behaviors of the servant and how the staff thought about the organization in general. This information was important as it gives author’s hospital insights on improving the welfare of their staff as well as their retention. The organization further has relevant in author’s hospital in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia where decision-making is paternalistic in nature. The review therefore gave findings that correspond to what servant leadership should do to organizations and the healthcare in order to maximize their benefits (Anonymous, 2014, pp. 3).
5.2 Recommendations
There remain many areas of concern with regard servant leadership that requires exploration and answering such as whether servant leadership can be enhanced through training and education. Perhaps this could serve as the beginning of the debate whether servant leaders are born, bred or merely created as the organization tries to execute its mandates and objectives. It is also recommended that future studies on servant leadership in healthcare should be carried out in an empirical format to explore the antecedents of servant leadership. This includes whether servant leadership is inherent in an individual, latent or should be developed in the individual exercising leadership responsibilities
More important to any study of servant leadership is that it should be seen and theorized not only on the basis of the arguments by one scholar but by incorporating other theories such as those by the servant leadership scholars. This would enrich the scholarly work on this as well as give insights for future studies on servant leadership. I hope that this piece of systematic review has set adequate ground for students, scholars, managers, leaders and practitioners of servant leadership on the intellectual path for servant leadership training and practice (Anonymous, 2014). The importance of this systematic review therefore as has been shown is that it gives an analysis of servant leadership as practiced organizations. Further, it provides insights into what servant leaders can do in order to improve the working environment of their followers. In summary, the importance of servant leadership in organizations cannot be underestimated, and all organizations are required to adopt servant leadership. This would help organizations to be more productive in what they do and therefore have a competitive advantage over competitors as it has satisfied and appreciate employees.
References
Ahmed, A., 2009. Staff suggestion scheme (3Ss) within the UAE context: Implementation and critical success factors. Education, Business and Society: Contemporary Middle Eastern Issues, 2(2), 153-167.
Al-Dabbagh, M., 2009. The Context for Intergroup Leadership among Women’s Groups in
Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia. In Todd Pittinsky (Ed.): Crossing the Divide: Intergroup Leadership in a World of Difference. Boston: Harvard Business School Press.
Alhari, M. and Yusoff, R., 2012. Leadership Styles and Their Relationship with Quality
Management Practices in Public Hospitals in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia. International Journal of Economics and Management Sciences, 1(10), pp. 59-67.
Amadeo, C., A. (2009). A correlational study of servant leadership and registered nurse job
satisfaction in acute health-care settings. University of Phoenix.
Anderson, B. J., Manno, M., O’Connor, P., & Gallagher, E. (2010). Listening to nursing
leaders: using national database of nursing quality indicators data to study excellence in nursing leadership. Journal of Nursing Administration, 40(4), 182-187.
Anderson, Kelly Preston. (2005). A correlational analysis of servant leadership and job
satisfaction in a religious educational organization. Unpublished dissertation. University of Phoenix, Arizona.
Anthony et.al, (2005). Leadership and nurse retention: the pivotal role of nurse managers.
Journal of Nursing Administration, 35(3), 146-155.
Anonymous. 2014. Does Servant Leadership Really Exist Johnson & Wales MBA Program,
- 2-8. Available at: https://static.squarespace.com/static/53cd2303e4b01d0b9ff20256/t/53cd9cd6e4b0a11d418034b0/1405983958688/Servant+Leadership.pdf [Accessed on 4 Jan 2015].
Ashill, N. J., Caruthers, J., & Krisjanous, J. (2006). The effect of management commitment
to service quality on frontline employees’ affective and performance outcomes: an empirical investigation of the New Zealand public healthcare sector. International Journal of Nonprofit and Voluntary Sector Marketing, 11(4), 271-287.
Autry, J. A. (2002). The servant leader. New York, Random House International.
Avolio, B. J. and Locke, E. E., 2002. Philosophies of leader motivation: Altruism versus egoism. Leadership Quarterly, 13, pp. 169-191.
Avolio, B., Gardner, W., Walumbwa, F., & May, D. (2004). Unlocking the mask: A look at the process by which authentic leaders impact follower attitudes and behaviours. Leadership Quarterly, 15(6), 801-823.
Baker, D.P., Day, R. & Salas, E., 2006. Teamwork as an essential component of high-reliability
organizations. NCBI: Health Services Research, 4(2), pp.1576-98.
Burbuto, J. E., & Wheeler, D. W. (2006). Scale development and construct clarification of
servant leadership. Group & Organization Management, 31(3), 300-326.
Barr, J., & Dowding, L. (2012). Leadership in health care. Los Angeles, Sage.
Baron, T. (2010). The art of servant leadership: designing your organization for the sake of
others. Tucson, Arizona, Wheatmark.
Bass, B. M. (1985b). Leadership and performance beyond expectations. New York: The Free
Press.
Bass, B. M., & Avolio, B. J. (1997) Manual for the Full Range of Leadership. Binghamton,
Bass, Avolio & Associates, N.Y.
Bass, B. M., 2000. The future of leadership in learning organizations. The Journal of
Leadership Studies, 7(3), pp. 18-40.
Bass, B. M. (1990). Bass and Stogdill’s handbook of leadership: Theory, research, & managerial applications. New York: The Free Press.
Bass, Bernard M. & Riggio, Ronald E. (2008). Transformational leadership (2nd ed.). NJ: Lawrence Erlbaum Associates, Inc.
Bhindi, N. & Duignan, P. (1997) Leadership for a new century. Educational Management &
Administration, 25(21), pp. 117-133.
Birks, Y. F., & Watt, I. S. (August 01, 2007). Emotional intelligence and patient-centered
care. Journal of the Royal Society of Medicine, 100, 8, 368-374.
Black, Glenda Lee. (2010). Correlational analysis of servant leadership and school climate.
Catholic Education: A Journal of Inquiry and Practice, 13(4).
Blanchard, K. H., & Hodges, P. (2002). The servant leader: transforming your heart, head,
hands & habits. Nashville, Tenn., J. Countryman.
Boyum, G. (2008). The Historical and Philosophical Influences on Greenleaf’s Concept of
Servant Leadership: Setting the Stage for Theory Building.
Buchen, I. H. (1998). Servant Leadership: A Model for Future Faculty and Future
Institutions. Journal of Leadership Studies. 5, 125-134.
Cerit, Yusuf. (2009). The effects of servant leadership behaviours of school principals on
teachers’ job satisfaction. Educational Management Administration Leadership, 37(5), 600-623.
Center for Reviews and Dissemination (CRD). (2008).CRD’s guidance for undertaking
reviews in healthcare (ISBN 978-1-900640-47-3).Retrieved from https://monkessays.com/write-my-essay/york.ac.uk/inst/crd/pdf/systmayic_review_reviews.pdf
Cochrane Collaboration. (2014). Cochrane handbook for systematic reviews of interventions.
Retrieved October 14, 2014, from https://monkessays.com/write-my-essay/cochrane.org/training/cochrane-handbook
Cook, D. J., Mulrow, C. D., & Haynes, R. B. (1997). Systematic reviews: Synthesis of best
evidence for clinical decisions. Annals of Internal Medicine, 126(5), 376–380.
Damen, F., Knippenberg B. and Knippenberg, D., 2008. Affective match: Leader emotional displays, follower positive effect, and follower performance. Journal of Applied Social Psychology, 38, pp. 868–902.
Day, D., 2001. Leadership development: A review in context. Leadership Quarterly, 11 (4),
- 581-613.
Dennis, R. S., & Bocarnea, M. (2005). Development of the servant leadership assessment
instrument. Leadership & Organization Development Journal, 26(8), 600-615.
Dennis, R., & Winston, B. E. (2003). A factor analysis of Page and Wong’s servant
leadership instrument. Leadership & Organization Development Journal, 24(8), 455-459.
De Pree, M. (2002). „Servant-leadership: Three things necessary‟. Focus on leadership:
Servant leadership for the, 21, 89-100.
Dorgham, S. and Al.Mahmoud, S., 2013. Leadership Styles and Clinical Decision Making Autonomy among Critical Care Nurses: A Comparative Study. IOSR Journal of Nursing and Heath Sciences, 1(4), pp. 71-83.
Druskat, V. U. and Pescosolido, A. T., 2002. The content of effective teamwork mental models in self-managing teams: Ownership, learning, and heedful interrelating. Human Relations, 55, pp. 283-314.
Egger, M., Smith, G. D., & O’Rourke, K. (2001). Rationale, potentials and promise of
systematic reviews. In M. Egger, G. D. Smith, & D. G. Altman (Eds.), Systematic reviews in health care: Meta-analysis in context (2nd ed., pp. 3–19). London: BMJ Publishing Group.
Ehrhart, M. G. (2004). Leadership and procedural justice climate as antecedents of unit level
organizational citizenship behavior. Personnel Psychology, 57, 61-94.
Euwema, M. C., Wendt, H. and Emmerik, H., 2007. Leadership styles and group
organizational citizenship behavior across cultures. Journal of Organizational Behavior, 28, pp. 1035–1057.
Evans, James R., & Lindsay, William M. (2008). Managing for quality and performance
excellence (9th ed.). USA: Cengage Learning
Failla, K. R., & Stichler, J. F. (2008). Manager and staff perceptions of the manager’s
leadership style. Journal of Nursing Administration, 38(11), 480-487.
Farling, M. L., Stone, A. G., & Winston, B. E. (1999). Servant leadership: Setting the stage
for empirical research. Journal of Leadership & Organizational Studies, 6(1-2), 49-72.
Fisher, E. M., & Riley, T. A. (2005). Fostering the scholarship of discovery and integration
for advanced practice education. Nursing Education Perspectives, 26(6), 348-350
Garber, J. S., Madigan, E. A., Click, E. R., & Fitzpatrick, J. J. (2009). Attitudes towards
collaboration and servant leadership among nurses, physicians and residents. Journal of Interprofessional Care, 23(4), 331-340.
Garg, A. X., Hackam, D., & Tonelli, M. (2008). Systematic review and meta-analysis: When
one study is just not enough. Clinical Journal of The American Society of Nephrology, 3(1), 253–260.
Goleman, D. (1995) Emotional intelligence. Bantam, New York.
Graham, J. W. (1991). Servant-leadership in organizations: Inspirational and moral. The
Leadership Quarterly, 2(2), 105-119.
Green, S. (2005). Systematic reviews and meta-analysis. Singapore Medical Journal, 64(6),
Greenleaf, R. K. (1970). The Servant as a Leader. Indianapolis, IN: Greenleaf Center.
Greenleaf, R. K. (1977). Servant leadership: a journey into the nature of legitimate power
and greatness. New York, Paulist Press.
Greenleaf, R.K. (1991). The Servant As Leader .Westfield, Indiana: The Robert K. Greenleaf
Center.
Greenleaf, R. K. (1996). On becoming a servant-leader. San Francisco; Toronto, Jossey-
Bass.
Greenleaf, R., K. (1998). The Power of Servant Leadership: Essays by Robert K. Greenleaf;
Edited by Spears, L.C. (1998). San Francisco: Berrett-Koehler Publishers, Inc.
Greenleaf, R. K., & Spears, L. C. (1998). The power of servant-leadership: essays. San
Francisco, Calif, Berrett-Koehler Publishers.
Greenleaf, R. K. (2002). Servant leadership: A journey into the nature of legitimate power
and greatness. New York, Paulist Press.
Hackman,M.Z and Johnson, C.E. (1996), Leadership: A Communication perspective,2nd ed. ,
Waveland press, Prospect Heights, IL.
Hayhurst, A., Saylor, C., & Stuenkel, D. (2005). Work environmental factors and retention of
nurses. Journal of Nursing Care Quality, 20, 283-288. Retrieved January24, 2015,
from Journals Ovid
Hemingway, P., & Brereton, N. (2009). What is a systematic review Hayward Medical
Communications. Retrieved from https://monkessays.com/write-my-essay/medicine.ox.ac.uk/bandolier/painres/download/whatis/syst-review.pdf
Higgins, J. P., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of
interventions. The Cochrane Collaboration. Retrieved from
www.cochrane- handbook.org
Hayden, R. W. (2011). Greenleaf’s “best test” of servant leadership a multi-level analysis.
Thesis (Ph.D.)–University of Nebraska-Lincoln, 2011.
Horsley, T., Hyde, C., Santesso, N., Parkes, J., Milne, R., & Stewart, R. (2011). Teaching
critical appraisal skills in healthcare settings. Cochrane Database Of Systematic Reviews(11)
Howatson-Jones, I. L. (2004). The servant leader: Isis Lioba Howatson-Jones explores the
concept of leadership in the NHS, and explains why the servant leadership model is particularly applicable. Nursing Management, 11(3), 20-24.
Huber, D. (2013). Leadership and nursing care management. Elsevier Health Sciences
Hughes, R. G. (2008). Tools and Strategies for Quality Improvement and Patient Safety. In R.
- Hughes, Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville: Agency for Healthcare Research and Quality .
Jackson, D. (2008). Servant Leadership in Nursing: A framework for developing sustainable
research capacity in nursing. Collegian, 15(1), 27-33.
Jenkins, M., & Stewart, A. C. (2010). The importance of a servant leader orientation. Health
care management review, 35(1), 46-54.
Joseph, E. E., & Winston, B. E. (2005). A correlation of servant leadership, leader trust, and
organizational trust. Leadership & Organization Development Journal, 26(1), 6-22.
Khan, K., Sam, Kunz, R., & Kleijnen, J. (Eds.). (2003). Systematic reviews to support
evidence-based medicine: How to review and apply findings of healthcare research. London: Royal Society of Medicine Press.
Klenke, Karin. (2007). Authentic Leadership: A self, leader, and spiritual identity perspective. International Journal of Leadership Studies, 3(1), 68-97.
Koloroutis, M. (2004). Relationship-based care: a model for transforming practice.
Minneapolis MN, Creative Health Care Management.
Laub, J. A. (1999). Assessing the servant organization: development of the servant
organizational leadership assessment (SOLA) instrument. Thesis (Ed. D.)–Florida Atlantic University, 1999.
Liden, R. C., Wayne, S. J., Zhao, H., & Henderson, D. (2008). Servant leadership:
Development of a multidimensional measure and multi-level assessment. The Leadership Quarterly, 19(2), 161-177.
Marshall, E. S., & Marshall, E. S. (2011). Transformational leadership in nursing: from
expert clinician to influential leader. New York, NY, Springer.
Mayer, J. D., & Salovey, P. (1997). What is emotional intelligence In P. Salovey & D. J.
Sluyter (Eds.), Emotional development and emotional intelligence: Educational implications (pp. 3-31). New York: Basic Books.
McGee-Cooper, A., & Looper, G. (2001). The essentials of servant-leadership: Principles in
practice. Pegasus Communications.
Meade, M. O., & Richardson, W. S. (1997). Selecting and appraising studies for a systematic
review. Annals of Internal Medicine, 127(7), 531–537.
Melrose, K. (1995). Making the grass greener on your side: A CEO’s journey to leading by
serving. Berrett-Koehler Publishers.
Melnyk, B. M., & Overholt, E. F. (2005). Evidence-based practice in nursing & healthcare:
A guide to best practice. Philadelphia: Lippincott Williams and Wilkins.
Miller, W.C., 2004. The art of spiritual leadership in business: Developing a spiritual- based
organisational culture. Global Dharma Center.
Morse, G., Salyers, M., Rollins, A., Monroe-DeVita, M. and Pfahler, C., 2012. Burnout in
Mental Health Services: A Review of the Problem and Its Remediation. Adm Policy on Mental Health, 39(5), pp. 341-352.
Neill, Mark, Haywards, Karen S., Peterson, Teri. (2007). Students’ perceptions of the
inter-professional team in practice through the application of servant leadership principles. Journal of Interprofessional Care, 21(4), 425-432. DOI:10.1080/13561820701443512
Neill, M. W., & Saunders, N. S. (2008). Servant leadership: Enhancing quality of care and
staff satisfaction. Journal of Nursing Administration, 38(9), 395-400.
Northouse, P.G. (1997) Leadership: Theory and Practice. Sage Publications, Thousand Oaks.
Nix, W.(1997) Transforming Your Workplace for Christ, Boardman and Holmen,
Nashville,TN
O’Brien, M. E. (2011). Servant leadership in nursing: spirituality and practice in
contemporary health care. Sudbury, Mass, Jones and Bartlett Publishers.
Page, D., & Wong, T. P. (2000). A conceptual framework for measuring servant leadership.
The human factor in shaping the course of history and development. Lanham, MD:
University Press of America.
Parahoo, K. (2006). Nursing research: Principles, process and issues. London: Palgrave
Persily, C. A. (2013). Team leadership and partnering in nursing and health care.
http://public.eblib.com/choice/publicfullrecord.aspxp=1220298.
Macmillan. Patterson, K. A. (2003). Servant leadership: A theoretical model (Doctoral
dissertation, Regent University).
Patterson, K. A. (2003). Servant leadership: A theoretical model (Doctoral dissertation,
Regent University).
Peterson, M. H., Barnason, S., Ddonnelly, B., Hill, K., Miley, H., Riggs, L., & Whiteman, K.
(2014). Choosing the best evidence to guide clinical practice: Application of AACN levels of evidence. Critical Care Nurse, 34(2), 58–68.
Porr, C., & Mahtani-Chugani, V. (2008). How will RCTs provide evidence for this patient
Retrieved October 17, 2014, from Priory Medical Journals: http://priory.com/family_medicine/rct_evidence.htm
Rapisarda, B. A. (2002). The impact of emotional intelligence on work team cohesiveness
and performance. The International Journal of Organizational Analysis, 10 (4), 363-379.
Reynolds, K., 2011. Servant-Leadership as Gender-Integrative Leadership: Paving a Path for More Gender-Integrative Organizations through Leadership Education. Journal of Leadership Education, 10(2), 155-200.
Reynolds, K., N.D. Servant-leadership: A feminist perspective. International Journal of Servant Leadership, pp. 3-32.
Rogers, C., & Maslow, A. (2008). Carl Rogers. Information Theory, 214.
Rowe, R. (2003). Leaders as servants. New Zealand Management, 50(1), 24-26.
Russell, R. F. (2001). The role of values in servant leadership. Leadership & Organization
Development Journal, 22(2), 76-84.
Russell, R. F., & Stone, A. G. (2002). A review of servant leadership attributes: Developing a
practical model. Leadership & Organization Development Journal, 23(3), 145-157.
Russell, R. F., & Stone, A. G. (2002). A review of servant leadership attributes: Developing a
practical model. Leadership & Organizational Development Journal, 23(3), 145-147.
Salovey, P., & Mayer, J. D. (1990). Emotional intelligence. Intelligence, Cognition and
Personality, 9, 185-211.
Salie, A. (2009). Servant-minded leadership and work satisfaction in Islamic organizations:
A correlational mixed study. University of Phoenix.
Schermerhorn, J. R., Jr., Hunt, J. G., & Osborn, R. N. (2008). Organizational behavior (10th
Ed.). Hoboken, NJ: John Wiley.
Sackett, D. L., & Wennberg, J. E. (1997). Choosing the best research design for each
question. BMJ: British Medical Journal, 315(7123), 1636
Sendjaya, S., & Sarros, J. C. (2002). Servant leadership: Its origin, development, and
application in organizations. Journal of Leadership & Organizational Studies, 9(2), 57-64.
Sendjaya, S. (2003, October 16). Development and validation of servant leadership Behavior
Scale. Servant Leadership Roundtable, Regent University, Virginia Beach, VA. Available at: https://monkessays.com/write-my-essay/regent.edu/acad/cls/2003ServantLeadershipRoundtable/
Sendjaya, Sen & Pekerti, Andre. (2010). Servant leadership as antecedent of trust in
organizations. Leadership & Organization Development Journal, 31(7), 643 – 663.
Sendjaya, S., Sarros, J. C., & Santora, J. C. (2008). Defining and measuring servant
leadership behaviour in organizations. Journal of Management Studies, 45(2), 402-424.
Senge, P. M. (1995). Robert Greenleaf’s legacy: A new foundation for twenty-first century
institutions. Reflections on leadership: How Robert K. Greenleaf’s theory of servant-leadership influenced today’s top management thinkers, 217-240.
Sibbald, B., & Roland, M. (1998). Understanding controlled trials: Why are randomized
controlled trials important BMJ, 3316(7126), 201.
Sipe, J. W., & Frick, D. M. (2009). Seven pillars of servant leadership: practicing the
wisdom of leading by serving. New York, Paulist Press.
Smith, B. N., Montagno, R. V., & Kuzmenko, T. N. (2004). Transformational and servant
leadership: Content and contextual comparisons. Journal of Leadership & Organizational Studies, 10(4), 80-91.
Smith, C., 2005. Servant leadership: The leadership theory of Robert. K. Greenleaf.
Smith, C., 2005. Servant Leadership: The Leadership Theory of Robert K. Greenleaf [Online] Carol smith, 3-16. Available at:
https://monkessays.com/write-my-essay/carolsmith.us/downloads/640greenleaf.pdf [Accessed on 4 Jan 2015]
Spears, L. C. (1995). Reflections on leadership: How Robert K. Greenleaf’s theory of servant-
leadership influenced today’s top management thinkers. Wiley.
Spears, L. C., & Lawrence, M. (Eds.). (2002). Focus on leadership: Servant-leadership for
the twenty-first century. John Wiley & Sons.
Stanley, D., 2006. Recognizing and defining clinical nurse leaders. British Journal of
Nursing, 15(2), pp.108-11.
Stone, A. G., Russell, R. F., & Patterson, K. (2004). Transformational versus servant
leadership: A difference in leader focus. Leadership & Organization Development Journal, 25(4), 349-361.
Swearingen, Sandra & Liberman, Aaron. (2004). Nursing Leadership: Serving Those Who
Serve Others. Health Care Manager, 23(2), 100-109.
Torgerson, C. (2003). Systematic reviews. London: Continuum.
Trofino, J. (1995). Transformational leadership in health care. Nursing Management, 26(8),
42-49.
Trofino J. (1995). The brave New World of health care. The Canadian Nurse. 91, 28-32.
Tureman, D., 2013. The effectiveness of servant leadership in bringing about change.
Lynchburg: Liberty University.
Van Dierendonck, D. & Nuijten. I. (2010) The servant leadership survey: Development
and validation of a multidimensional measure. Journal of Business and
Psychology, 26(3)
Wagner-Marsh, F., & Conley, J. (1999). The fourth wave: The spiritually-based firm. Journal
of Organizational Change Management, 12(4), 292-302. Retrieved January 24, 2015, from ProQuest
Washington, R. R., Sutton, C. D., & Feild, H. S. (2006). Individual differences in servant
leadership: The roles of values and personality. Leadership & Organization Development Journal, 27(8), 700-716..
Webb, C., & Roe, B. H. (2007). Reviewing research evidence for nursing practice:
Systematic reviews. Oxford: Blackwell Publishing.
Winston, B. E. (2004). Servant leadership at Heritage Bible College: A single-case study.
Leadership & Organization Development Journal, 25(7), 600-617.
Winston, B. E. (2003). Extending Patterson’s servant leadership model: Write my Essay Online Writing Service with Professional Essay Writers – Explaining how
leaders and followers interact in a circular model. Unpublished manuscript presented at Servant Leadership Research Roundtable, Regent University, Virginia Beach, VA.
Wong, M. Y., & Cheng, M. H. (2012). Effects of motivational interviewing to promote
weight loss in obese children. Journal of Clinical Nursing, 22(17–18), 2519–2530.
Wong, P. T., & Page, D. (2003, October). Servant leadership: An opponent-process model
and the revised servant leadership profile. In Proceedings of the Servant Leadership Research Roundtable.
Yukl, G. (2006). Leadership in organizations (6th ed.). Upper Saddle River, NJ: Pearson
Prentice Hall.
