Servant and Transformational Leadership

Running head: SERVANT AND TRANSFORMATIONAL LEADERSHIP 1

Servant and Transformational Leadership: Common Misconceptions in the Healthcare Field

Amanda Bryant

Siena Heights University

Servant Leadership, Employee Satisfaction, and Organizational Performance in Rural

Community Hospitals

SERVANT AND TRANSFORMATIONAL LEADERSHIP 2

McCann, Graves, & Cox (2014) report, that servant leadership has a positive impact on

employee and customer satisfaction. McCann et al. (2014), support this claim by asking the

following questions: to what degree are leaders in rural community hospitals servant leaders,

what the level of employee satisfaction in rural community hospitals is, and what is the

relationship between servant leadership, employee satisfaction, and the Hospital Consumer

Assessment of Healthcare Providers and Systems (HCAHPS) scores? McCann, et al. (2014)

imply that transformational leadership is not as effective as servant leadership. McCann, et al.

(2014) leaves open the question as to what servant leadership would be like with

transformational leadership and what it would be like if the survey area was expanded. First,

servant and transformational leadership will be defined. Next, the two will be compared. Finally,

the relationship between servant and transformational leadership, employee and job satisfaction,

and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores

will be discussed.

Transformational leadership employed with servant leadership can help an organization

reach their goals. The data collected by McCann, et al. (2014) between December 2013 and

January 2014 involved participants, limited to employees from 10 rural community hospitals -

located in the southeastern region of the United States. However, expanding the survey area to a

larger population will allow any flaws or inaccurate data to become visible. The degree of

servant leadership, employing some degree of transformational leadership, level of employee

satisfaction, the relationship between servant leadership, employee satisfaction, and the

(HCAHPS) scores, gives us an idea of why servant leadership is important, and why the data

collection area should be expanded.


Ultimately what is at stake here is the health and well-being of the community. McCann

et al.’s (2014) theory on "Servant Leadership" is extremely useful because it sheds light on the

difficult problem of patients receiving unethical service from leadership and employees. Running

an organization, patients must come first, above how much money an organization may make, in

order for leadership to see ethics at work. As a result, everything else will fall into place. Ethics

is important when it comes to patient satisfaction. This is a part of bowing down to others.

Cloud (2006) touched on the concept of bowing down to others in his book Integrity: The

Courage to Meet the Demands of Reality. In Cloud’s (2006) view, “to live and flourish, we must

bow to the things larger than us” (p. 240). In other words Cloud (2006) believes others should be

put first in order for organizations to rise to their full potential. He utilizes two great examples

referring to his quote. The first example was a US Navy ship, the second was a company moving

to a new building for a better opportunity. In the case with the Navy ship, it wanted the

lighthouse to change its coordinates. There was some going back and forth as to who needed to

change coordinates. In the case with the company moving to a newer building with their

employees, one of the employees concerned himself with his current window office. In the

employees words, “does that mean I am going to lose my window office” (Cloud, 2006, p. 243)?

In both cases, neither chose to look at the bigger picture. This goes back to servant leadership.

Being a servant leader means to “bow down” to patients and employees. Cloud (2006) agrees

when he writes, “we can push the limits all we want, thinking they will move, but ultimately we

will bow down to them” (p. 240). In making this comment, Cloud (2006) urges healthcare

officials to look past current circumstances and into the future.


Evaluating the degree of servant leadership in rural community hospitals involves

utilizing descriptive statistics. The descriptive statistics included altruistic and emotional healing,

wisdom, persuasive mapping, and organizational stewardship (McCann et al., 2014). Generally

speaking, they are all needed to provide servant leadership to patients. The results displayed that

leaders performed as servant leaders 50% of the time. According to Tiaki (2014), “servant

leadership is a philosophy in which the manager inspires. There are 10 principles of servant

leadership, they include: listening, empathy, healing, awareness, persuasion, conceptualization,

foresight, stewardship, commitment to the growth of people and building community” (para. 1).

Taiki’s (2014) point is that, the principles combined with the philosophy, creates someone that is

willing to serve other over their own needs. Transformational leadership, on the other hand, is

dissimilar when utilized alone.

According to Mohammad, AL-Zeaud, & Batayneh (2011), “a transformational leader is

described as a person of vision, creativity and inspiration who leads the change” (p. 35).

Transformational leadership is not as effective as servant leadership, alone. Berendt, Christofi,

Kasibhatla, Malindretos, & Maruffi (2012), all argue that transformational leadership “can more

broadly and deeply contribute to an organization’s success over the long term” (para. 1). This

leadership style has an indirect impact on patient satisfaction. It focuses on the organization, and

goals set by leadership for the organization directly. Caillier (2015) writes about the four major

components of transformational leadership, which include idealized influence, inspirational

motivation, individualized consideration, and intellectual stimulation. While utilizing these

components, leaders surely earn respect and trust from employees, establish high expectations,

provide special attention to each employee's need, and challenge the status quo. In other words,

Caillier (2015) believes these four components play a major role in leadership. Although the


dimensions including, gaining respect and trust from employees, adding meaning and challenges

to employee roles, paying attention to employee needs, and encouraging rational thought, are all

important, none of these traits of transformational leadership focus on patient satisfaction

directly. There is no direct relationship with patients. The focus of transformational leadership

includes satisfying the organization first. Patient satisfaction comes second.

When comparing the two leadership styles, transformational leadership does in fact

“broaden and deepen contribution to an organizations long term success” (Berendt et. al., 2012,

para. 1). However, patients are not involved in this process. The essence of Brendt et al.’s (2015)

argument is that, patients and employees are cut out of the process in an effort to focus on the

goals of the organization itself. Leaders care for patients indirectly, and patient complaints and

concerns are not taken into consideration. This results in patients going to other organizations

and ultimately filing more complaints. Comparatively, patients like to see what is called “salt and

light” (Hayhoe, para. 1, 2013). They like to see flavor added to their service, and enjoy being

served well. Caring for patients directly allows them to know who matters most. This has been

shown in the studies on servant leadership. Servant leadership involves a different thought

process. Those unfamiliar with this school of thought may be interested to know that servant

leadership basically boils down to patient satisfaction. It involves leadership primarily taking a

patient’s needs and feelings into consideration first.

A study was performed by Mohammad et al. (2011) in Amman, Jordan focusing on

transformational leadership and job satisfaction of registered nurses in private hospitals.

Surveyors utilized The Minnesota Satisfaction Questionnaire (MSQ), and Multifactor Leadership

Questionnaire (MLQ) to measure the two factors. 200 surveys were mailed, Pearson r


correlation, and summary and descriptive statistics were used. Results show a positive

correlation between the dimensions of transformational leadership and the dimensions of job

satisfaction. In Mohammad et al.’s (2011) view, the strongest relationship between internal job

satisfaction and transformational leadership has been visible among the intellectual stimulation

dimension. In other words, there is a positive correlation between job satisfaction and

transformational leadership. Healthcare officials question whether transformational leadership is

as effective as the citizens of Jordan claims it to be. According to McCann et al. (2014),

“employees are in fact motivated by servant leadership to go above and beyond the basic

requirements of the job responsibilities in their interaction with customers” (p. 30). What about

the level of employee satisfaction?

To determine the level of employee satisfaction in rural community hospitals, descriptive

statistics were used. This time the subscales included extrinsic, intrinsic, and general satisfaction.

McCann et al. (2014) states results that indicate “general satisfaction is closer to satisfied than

dissatisfied” (p. 34), meaning that external, internal, and general factors all play a role in

employee gratification. This indicates that employees enjoy having and being servant leaders.

This makes them want to do their job, and treat patients well. Transformational leadership is not

a bad thing to include in leadership. However, it should be applied with servant leadership to get

maximum results, because it does not involve patients directly. Although it is granted that

transformational leadership is not as effective as servant leadership, it is still insisted that with

the expanded survey area, there is a better view of the significance of servant leadership.

When employees are willing and able to perform their jobs, then there is a known

increased contribution. There is an increased contribution, because they are not forced to perform


their jobs. This allows employees to be servant leaders, this is what their leaders persuaded them

to do. As a result, employees with servant leaders take control of their own engagement. This has

a lot to do with personal values, goals, and visions. The scores presented comparing servant

leadership, employee satisfaction, and the (HCAHPS) scores in rural community hospitals,

indicated a positive correlation between all three. The study included subscales from both studies

above. Including extrinsic satisfaction, intrinsic satisfaction, general satisfaction, altruistic and

emotional healing, wisdom, persuasive mapping, and organizational stewardship. Pearson r

correlation and significant variables were also used.

The evidence from the Pearson r correlation, The Multivariate of Variance (MANOVA),

and descriptive statistics, performed on servant leadership in rural community hospitals, shows,

employees are more than willing to do their jobs when their leaders possess the skills of a servant

leader. Employees take control of their engagement, and are satisfied. During the two descriptive

statistics analysis, because “supervisor behavior ranged from behaving as a servant leader to

behaving that way often,” (McCann et al., 2014, p. 33), employee satisfaction was justified. The

behavior of supervisors is brushed onto employees. They recognize that engagement is a daily

responsibility. Furthermore, including a larger population in the survey allows the results from

both data sets to appeal to a larger crowd. This crowd not only includes patients, leaders, and

employees in rural community hospitals, but also international communities near and/or around

Jordan. It allows a visual of a much broader aspect of servant and transformational leadership.

Pearson r correlation, The Multivariate of Variance (MANOVA), and descriptive

statistics were all performed to motivate others to want to be servant leaders. The studies

challenge the work of early researchers who tend to assume that transformational leadership


could be used alone. The questions McCann et al. (2014) asks make a great point about servant

leadership, and helps answer the question of what it would be like if leadership was

transformational. Servant leaders nonetheless create a healthier working environment than

transformational leaders. In order for someone to be a servant leader, “they have to have the

natural feeling of wanting to serve” (Parris & Peachey, 2013). McCann et al. (2013) is warning

that it cannot be forced on an employee to do something they do not naturally want to do. Again,

transformational leaders work toward the goal of the organization while servant leaders focus

solely on employee and patient satisfaction. Data from McCann et al. (2014), and Mohammad et

al.’s (2011) studies’ suggest that, servant leadership has a positive impact on employee and

customer satisfaction in rural community hospitals. Which in turn, has a positive impact on

employee behavior. Though it is conceded that servant leadership is necessary for patient

satisfaction, it is still insisted that including a larger population will allow a much broader view

of the positive effect it has on an organization.

After defining servant and transformational leadership, comparing them, and finally

discussing the relationship between servant and transformational leadership, employee and job

satisfaction, and the (HCAHPS) scores, the expanded population displays the significance of

servant leadership. According to Ashish (2008), “this portrait of patients’ experience in hospitals

offers insights into areas that need improvement, and that hospitals should provide both a high

quality clinical care and a good experience for the patient” (para. 4). The essence of Ashish

(2008) argument is that studies like this express the need for improvement in hospitals. Brendt et

al. (2012) writes “theorists promote the idea that ineffective executives leading organizations

attempt to disguise mismanagement by unethical and even criminal acts and then exacerbate the

damage with deception (para. 2). While the findings from the study done by Caillier (2006) show


that transformational leadership “has a positive effect on employee evaluations” (para. 1),

servant leadership has a positive effect on the organization as a whole. Servant and

transformational leadership, employee fulfilment, the connection between servant leadership,

employee fulfillment, and the Hospital Consumer Assessment of Healthcare Providers and

Systems (HCAHPS) scores, shows why servant leadership is important, and why the data

collection area should be expanded. It is understandable that transformational leadership is

“theoretically and empirically” (Mohammad et al., 2011, p. 36) proven, however, this does not

dismiss its effectiveness on patient satisfaction.

References

Ashish, K. J. M. M. (2008). Patients' Perception of Hospital Care in the United States. The New

England Journal of Medicine, 1921–1931. http://doi.dx.org/10.1056/NEJMsa0804116

Berendt, C. J., Christofi, A., Kasibhatla, K. M., Malindretos, J. & Maruffi, B. (2012).

http://doi.dx.org/10.1056/NEJMsa0804116


Transformational leadership: lessons in management for today. International Business

Research, 5 (10), 227–232. http://doi.dx.org/10.5539/ibr.v5n10p227

Caillier, J. G. (2015). Toward a better understanding of the relationship between transformational

leadership, public service motivation, mission valence, and employee performance: a

preliminary study. Public Personnel Management, 43 (2), 218. Retrieved from

http://dx.doi.org.ezproxy.sienaheights.edu:2048/10.1177/0091026014528478

Cloud, D. H. (2006). Integrity: The courage to meet the demands of reality. New York, NY:

HarperCollins Publishers.

Hayhoe, (2013). Salt and light: Lives of faith that shaped modern China. Pacific

Affairs, 86(2), 401-405. Retrieved from

http://search.proquest.com/docview/1372880794?accountid=28644

McCann, J. T., Graves, D., & Cox, L. (2014). Servant leadership, employee satisfaction, and

organizational performance in rural community hospitals. Retrieved September 11, 2015

from FILE:///C:/Users/Amanda/Downloads/McCann,%Graves,%20&%20Cox%20-

%20Servant%20Leadership(1).pdf

Mohammad, S., AL-Zeaud, H., & Batayneh, A. (2011). The relationship between

transformational leadership and employees' satisfaction at Jordanian private hospitals.

Business & Economic Horizons, 5 (2), 35–46.

Parris, D. L. & Peachey, J. (2013). A systematic literature review of servant leadership theory in

http://doi.dx.org/10.5539/ibr.v5n10p227


organizational contexts. Journal of Business Ethics, 113 (3), 377-393

http://doi.dx.org/10.1007/s10551-012-1322-6

Tiaki, K. (2014). What is servant leadership? Nursing New Zealand, 20 (1), 19.

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Servant and Transformational Leadership