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LEADERSHIP STYLE AND ITS RELATIONSHIP TO
CULTURE IN AN AGING SERVICES PROVIDER ORGANIZATION:
A CASE STUDY UTILIZING FLEXIBLE DESIGN
by
Michele D. Holleran
A Dissertation Presented in Partial Fulfillment
Of the Requirements for the Degree
Doctor of Philosophy
Capella University
December 2006
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UMI Number: 3239154
3239154
2007
Copyright 2007 by
Holleran, Michele D.
UMI Microform
Copyright
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unauthorized copying under Title 17, United States Code.
ProQuest Information and Learning Company300 North Zeeb Road
P.O. Box 1346
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All rights reserved.
by ProQuest Information and Learning Company.
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Michele D. Holleran, 2006
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Abstract
Leadership characteristics that foster culture change and staff retention in an organization
providing housing and services to the aging are uncovered using a microanalysis technique in
this embedded case study. Although recent research (Thyer, 2003) in healthcare environments
conclude that transformational leadership (Bass & Avolio, 1990; Burns, 1978) is the style most
conducive to achieving the two outcomes, the author of this dissertation posits that elements of
Level 5 leadership (Collins, 2001) and servant leadership (Greenleaf, 1991) are also critical.
Culture change and staff retention are imperative to the vitality and success of the aging services
field over the next 2 decades.
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Dedication
I dedicate this dissertation to Robert L. Wenrich, my father, lifelong friend and mentor,
and an extraordinary educator.
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Acknowledgments
I would like to acknowledge the people who have helped me in my journey to attain a
PhD. First, I thank my parents, Robert and Karol Wenrich, who always emphasized the
importance of education and giving my best to any endeavor. My parents have always been my
greatest cheerleaders, and for that I am eternally grateful to them.
Second, I express heartfelt appreciation to my husband, Brad Holleran, and our children,
Robbie and Shannon, who were patient and understanding over the past 5 years while I had my
nose in hundreds of books and articles preparing for this degree. I especially appreciate the
encouragement of my husband and the many nights he prepared dinner so I could pursue my
studies. I am grateful to my husbands parents, Bert and Barb Holleran, for their support and
inspiration throughout this process. I also would like to acknowledge the love and
encouragement of my three sisters, Melinda Scott, Kathy Stoltzfus, and Jennifer West.
My business partners, Lisa Lehman and Cindy Osborne at Holleran Consulting, are
appreciated for their unending support and carrying the load of the business affairs while I was
pursuing this degree. My appreciation is also extended to Dr. Nancy King, Dr. Kathryn Roberts,
and Janet Green, three professional colleagues who served as peer reviewers for my dissertation.
A special note of thanks goes to my mentor, Dr. Mary Evans, for the many times she
offered advice over coffee and by phone. I appreciate all the times she challenged me to think
harder and check my assumptions. To Dr. Edward Felton Jr., I owe gratitude for his guidance,
friendship, and incredible sense of humor. I also thank Dr. Shanker Menon, the third member of
my committee, for his wisdom. I am also grateful to my adviser, Dr. Mark Larson of Capella
University, who helped me negotiate through many details, especially during the final phases of
writing this dissertation.
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Recognition of all members of the organization about which this case study research is
written is appropriate, especially the CEO and the Director of Communications, who were so
very gracious with their cooperation during this process. I also wish to acknowledge the 37 other
individuals who allowed me to interview them for this study.
Finally, my thanks to Susan Werner and Kathy Flavin, who provided technical support
and friendship to me as I completed this dissertation.
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Table of Contents
Acknowledgments iv
List of Tables ix
List of Figures x
CHAPTER 1. INTRODUCTION 1
Introduction to the Problem 1
Background of the Study 4
Statement of the Problem 5
Purpose of the Study 6
Rationale 7
Research Questions 8
Significance of the Study 9
Definition of Terms 10
Assumptions and Limitations 12
Nature of the Study or Theoretical/Conceptual Framework 12
Organization of the Remainder of the Study 15
CHAPTER 2. REVIEW OF THE LITERATURE 16
Rationale for the Research 16
Theory Generating the Question and Exploring the Foundations of the Field 17
Summary 35
CHAPTER 3. METHODOLOGY 38
Purpose of the Study 38
Theoretical Framework: Initial Research Questions and Objectives 41
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Research Design 41
Rationale for Methodology 42
Sampling Design 44
Procedures for Consent to Participate, Participants at Risk and Confidentiality 46
Methods and Procedures for Data Collection, Including Researcher Participation 47
Data Analysis Procedures 49
Limitations of Methodology 50
Ethical Issues 52
CHAPTER 4. DATA COLLECTION AND ANALYSIS 54
About the Organization 56
Interviews and Focus Groups 56
How Data Were Coded 58
Open Coding of the Data 63
Leadership Characteristic 1: Transparency 68
Leadership Characteristic 2: Trustworthiness 70
Leadership Characteristic 3: Connectivity 72
Leadership Characteristic 4: Accountability 75
Leadership Characteristic 5: Empowerment 79
Leadership Characteristic 6: Optimism 80
Discovery of Six Connector Concepts 83
Conceptual Framework 85
Conclusion 93
CHAPTER 5. RESULTS, CONCLUSIONS, AND RECOMMENDATIONS 95
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Other Findings Important to Note 97
Application of the Conceptual Framework 99
Research Recommendations 101
How the Conceptual Framework Relates to Other Leadership Theories 103
Conclusion 105
REFERENCES 107
APPENDIX A INTERVIEW AND FOCUS GROUP GUIDES 116
APPENDIX B DATA COLLECTION MATRIX 120
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List of Tables
Table 1. Participant Profile 55
Table 2. 2006 Nursing Home Turnover Statistics 62
Table 3. Leadership Characteristics Inspiring Culture Change 64
Table 4. Theoretical Underpinnings Associated With Identified Leadership Characteristics 65
Table 5. Disconfirming Evidence Noted Within Organizational Culture 67
Table 6. Similarities Between Constructs of Transformational Leadership 104
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x
List of Figures
Figure 1. Researchers original conceptual framework. 15
Figure 2. The dashboard. 78
Figure 3. Conceptual framework of leadership characteristics and connector conceptsleading to culture change and employee retention. 85
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CHAPTER 1. INTRODUCTION
Introduction to the Problem
The field of aging services faces challenges that threaten its future. Among these is a
labor shortage that will result in unprecedented vacancies and turnover rates among direct care
workers. Annual turnover rates today in aging services organizations range from 45% to 100%
depending upon the position to be filled. Among the most challenging is the position of certified
nursing assistant (CNA), which has a 71% annual turnover rate nationally. Significant societal
factors will result in a 21st century crisis in the long term care direct care workforce. The elderly
population requiring aging services is burgeoning (about 43% of persons turning 65 will require
skilled nursing care before they die) at a time when the care gap is increasing. Because of this
care gap, millions of elderly in the United States risk receiving insufficient or sub-standard care
from the nations network of aging services providers (U.S. Department of Health and Human
Services, 2004).
The reasons for the care gap are many, but the major causes are low pay and insufficient
benefits, inadequate job orientation and the lack of mentoring, poor leadership and supervision,
physically and emotionally exhaustive work, workplace stress and burnout and shortage in
staffing levels at individual facilities (Stone, 2001; Stone & Weiner, 2001). Generational
differences may contribute to misunderstandings among workers (Lancaster & Stillman, 2002).
Moreover, the culture of aging services is viewed as being highly-transactional (authoritative,
task-focused), which is believed to contribute to the high turnover of staff (Thyer, 2003). At the
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same time, the United States Bureau of Labor Statistics (USBLS, 2004b) forecasts the need for
more than 1.2 million new direct care workers by the year 2010.
Research conducted by the California Association of Homes and Services for the Aging
and the Institute for the Future of Aging Services (IFAS) found that a major source of job
dissatisfaction by direct care staff in long-term care settings was the feeling of not being valued
or respected by their supervisors. Bowers, Esmond, and Jacobson (2003), in their study to
determine why certified nursing assistants (CNAs) leave their jobs, discovered that high turnover
is directly connected to feelings of being unappreciated and undervalued. This connection points
to the need for empowerment of the workforce and higher trust levels between labor and
management within the aging services setting.
Parsons, Simmons, Penn, and Furlough (2003) performed a multivariate analysis of data
from a 1996 survey of nursing assistants employed in Louisiana nursing homes and confirmed
that professional growth, involvement in work-related decisions, supervision and communication
between management and employees were significantly correlated to turnover and job
satisfaction. Pennington and Magilvy (2003) came to similar conclusions in their research. Eaton
(2001) concluded that five managerial practices characterize environments with lower turnover
and better retention of direct care staff: (a) high quality leadership, (b) valuing and respect
toward direct caregivers, (c) positive human resource practices, (d) organizational environments
that are relationship-driven, and (e) sufficient staffing levels conducive to high quality care.
The connection between high turnover rates in healthcare organizations and transactional-
based cultures also is well documented. Thyer (2003) posited that the nursing shortage is being
caused by health care leadership that is transactional in nature, stating that nurses struggle
ideologically with the system in which they work. She wrote: nurses are not only disempowered
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through a transactional model; they also have minimal autonomy (p. 77). Thyer recommended
adoption of Eusons model of team communication as one way to begin empowering direct care
nursing staff such as certified nursing assistants (CNAs). The model relies heavily on listening
and questioning, providing and receiving feedback, encouraging brainstorming and consensus-
building, empowerment, and promotion of a shared vision (Euson, 1994, p. 3). Laschinger and
Finegan (2005) found a similar relationship between empowerment and the retention of nurses
and other front-line workers in hospitals and long-term care facilities. They argued that work
environments manifesting justice, trust and respect facilitate a culture of retention.
Manion (2004) conducted research among 26 nurse managers from around the country
and discovered that cultures of retention come about when supervisors put the needs of their staff
first. Specific behaviors identified included caring about workers as individuals, treating them
with respect and high regard, using appreciation and recognition liberally, listening and being
responsive and providing support as required. Arruda (2005) found that the development of
trusting relationships between supervisors and their subordinates was the key to better retention.
Thyer (2003) posited that transformational leadership (a leadership style that emphasizes
relationship-building) has a positive affect on communication, team building and trust in a
hospital setting. Thyer stated that this particular leadership style is ideologically suited to
workplaces where nurses are employed because nurses are visionary, creative and involved in
decision making at the patient level (p. 73). Certain leadership styles are more compatible with
some organization structures, according to Paware and Eastman (1977). For example,
transactional leadership is found in bureaucratic organizations (Burns, 1978) and this is the type
of structure currently found in many healthcare organizations, including aging services facilities
such as nursing homes. Such an environment is characterized by top-down decision making,
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management by exception, disempowering strategies and lack of innovation. Low trust is also
found in purely transactional cultures (Kirkpatrick & Locke, 1996; Podsakoff et al., 1990).
The retention dilemma in aging services will have a significant negative impact on the
field. To reverse the negative trend, new cultural models have been developed, engendering
better communication, a sense of empowerment and organizational trust. These models need to
be implemented and sustained by leaders capable of transforming healthcare and aging services
organizations from bureaucratic and authoritarian institutions to work environments where
employees want to stay and grow their careers over time.
Background of the Study
The organization selected as the focus for the proposed research is a leading provider of
housing and services for the aging in four states, employing nearly 4,000 persons, with 300 of
the workforce holding managerial level/supervisory positions. The annual overall staff turnover
rate is about 30%, which is significantly below the industry average. In one of the organizations
communities, turnover dropped from 74% to less than 10% within a year (K. Roberts, personal
communication, June 13, 2006). The provider organization to be examined has received
numerous awards for innovation and positive employment practices. For instance, the
organization was named Best Place to Work in an annual metropolitan survey of employees
for 2 consecutive years, in 2005 and 2006. The CEO took over the reins of the organization in
January 2003, succeeding an individual whose management style was considered authoritative
and transactional by board members. The new CEO was hired because she was perceived as a
transformational change agent. The CEOs efforts at the provider organization have resulted in
both financial and operational success. The CEO and management team are credited with
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empowering front line workers and encouraging innovation in their work (Does your workplace
have soul?, 2005).
During this CEOs tenure, innovation became a paramount value organizationally. The
staff at one of the provider communities started a catering service that serves the retirement
community as well as the greater community, netting $34,000 in operating income for the parent
provider organization. In the same organization, a 3-year education program that prepares
certified nursing assistants (CNAs) to become licensed practical nurses (LPNs), is heralded as a
model career pathing program in the aging services field. Another example of innovation is a
holistic approach to helping residents and families deal with the death of loved ones. A
maintenance worker at another senior center operated by the provider organization
conceptualized how to put electrical systems, furnaces and medical equipment online so that
crews can monitor them by computer and cell phones. These innovations or intra-preneural
ideas initiated by front line staff are shared with other staff members through a Website
accessible to all employees. In addition, a program recognizing innovative ideas has been
established.
Statement of the Problem
The provider organization in this study stands out in the field of aging services because it
represents a unique approach to leadership in an aging services organization. There are an
estimated 5,600 not-for-profit aging services providers in the United States. They are largely
viewed by consumers, the press and Congress as being in need of deep systemic change (Pioneer
Network, 2005). According to the Pioneer Network, relationships and person-centeredness are
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the fundamental building blocks of the transformed culture of the future and the promotion of
growth and individual development, a foundational value.
Culture change initiatives introduced to the field of aging services, such as the Pioneer
Network, The Wellspring Model, Greenhouse Project and Eden Alternative, have focused on
resident-centered care and empowerment of the staff who serve residents. These culture-change
programs and initiatives are designed primarily to work within an existing organizational and
leadership structure. The board of directors of the provider organization in this study has hired
from outside the aging services field an individual with a history and reputation for transforming
organizations. One question is whether the approach of hiring from outside the field has been a
successful one from the perspectives of the provider organization board members, the residents,
the community at large, and direct care supervisors and staff. If it is a successful approach in the
view of these stakeholder groups, a cogent argument can be made for approaching deep culture
change through the avenue of developing a leadership style other than the one traditionally found
in aging services provider organizations. Stone (2003) argued that there is no recipe for
organizational culture change. There is no perfect model of organizational and culture
change (p. 413). Therefore, the concept of changing the culture by changing the leadership
styles of those at the helm is a worthy topic for exploration.
Purpose of the Study
This research study utilizes a case study approach to better understand the role of
leadership in aging services organizational culture change. Research results identify that the
existence of specific leader characteristics has played an important role in changing the culture of
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an aging services environment. The research also identifies how these characteristics interface
with existing leadership theories.
Rationale
Eisenhardt (1989) made an argument that case study is ideally suited for knowledge
creation leading to theory-building. Because case study emphasizes detailed contextual analysis
of a limited number of events, conditions and their inter-relationships, it is useful in providing
the application of ideas to the real world. Yin (1984) wrote that case study is especially useful
when the boundaries between phenomenon and context are not clearly evident (p. 23).
Multiple data collections are used in case study research, and methods that employ both
qualitative and quantitative datasets as well as other sources of information, allow for a robust
substantiation of constructs and hypotheses.
Thyer (2003) utilized a case study method to compare the effects of transactional and
transformational leadership on health care teams in a hospital setting. She found that direct care
staff members were able to ignite creativity and problem-solving skills under a transformational
culture because of the trust that exists between leader and team members. Laschinger, Almost,
and Tuer-Hodes (2003) conducted nursing case studies that link structural empowerment to
factors identified as important to retention, including job satisfaction. Buerhaus, Staiger, and
Auerbach (2000) concluded in their case study work that creating conditions that empower
nurses and direct care staff fosters an atmosphere of respect that attracts and retains a sustainable
workforce in healthcare settings. Based on research involving 159 interviews and 100 hours of
direct observation in a hospital environment, Eaton (2001) discovered that five managerial
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practices characterize environments with lower turnover and better retention of nursing staff.
Heading the list was high quality leadership.
Research Questions
This research study will use a case study approach to understand the relationship among
leadership style, empowerment, and culture in an aging services organization. Several research
questions will be explored to facilitate this understanding.
1. How are the leadership style(s) of the CEO and the top management team describedby key stakeholders of the organization? Is the leadership style identified by thesestakeholders one that utilizes empowerment to affect culture change within theorganization? What are the specific behaviors exhibited by the CEO and topmanagement team in their leadership styles? Can these behaviors be matched to theconstructs of one or more leadership style models?
2. How do selected stakeholder groups associated with the provider organization defineempowerment, and do they believe it exists within the organization? Why do theybelieve or not believe that empowerment exists within the organization? Ifempowerment does exist from their perspectives, how has it contributed (if at all) tocreating a culture of retention? What do the CEO and top management team perceivethey are doing to empower members of the organization, and what do they believehas been the impact? Is there evidence that points to the existence of empowerment
within the organization?
3. How is the current organizational culture described by the various stakeholder groupsof this provider organization? Is there alignment evidenced in their perceptions? Towhat degree do the stakeholders view the leadership style of the CEO andmanagement team as contributors to the organizational culture? How has the cultureevolved since the time when the previous CEO/management team left the providerorganization? In which specific ways has this evolution occurred?
4. What lessons can be learned from this case study and potentially applied to otheraging services providers who are attempting to implement deep culture change for the
purposes of better staff retention? What other research questions deserve explorationin the future?
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Significance of the Study
Eaton (2001) concluded that even in a complex system, one person could make a vast
difference (U. S. Department of Health and Human Services, p. 9), contributing to reduction of
turnover and better retention of direct care staff. Taylor (2004) reported that leaders and their
skill in building a climate of retention, a culture that speaks to employees in a way that
encourages them to stay, will be an organizations best defense against unwanted turnover.
Leaders are the secret weapon in keeping valued talent longer (p. 43). Leadership is believed to
be a critical success factor in the culture change movement, which is seen as necessary to gain
the publics trust of aging services providers in the United States. In fact, the American
Association of Homes and Services for the Aging (AAHSA), the largest professional association
representing non-profit aging services providers, has declared this time as the era of leadership
in our field. The association recently instituted a program entitled Leadership AAHSA, the focus
of which is to identify and train emerging leaders. In the field of aging services, there is
widespread support for leadership styles emphasizing empowerment, communication,
collaboration and individual relationship-building may contribute to a culture of retention (Stone
& Wiener, 2001). Three leadership styles that emphasize some or most of these behaviors and
activities include transformational leadership, servant leadership and Level 5 leadership (Popper,
2004).
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Definition of Terms
Aging services.Provider organizations who offer one or any combination of the
following services: senior housing, adult day care, assisted living, skilled nursing, home health
care to the elderly, hospice, and rehabilitation services for the aged.
Provider organization.The organization that provides aging services to senior
populations. A provider organization can be a single site facility (such as a nursing home) or a
multi-site organization offering many types of services for seniors under one corporate umbrella.
Culture.Schein (2004) defined culture as a pattern of shared basic assumptions that was
learned by a group as it solves its problems of external adaptation and internal integration (p.
17).
Culture of retention.Manion (2004) interviewed nurse leaders who defined a culture of
retention as the creation of a work environment where people want to stay; a culture of
engagement and contribution (p. 30).
Direct care staff.Employees of healthcare organizations, such as hospitals and aging
services providers, who deliver direct care to patients and residents. These individuals include
certified nursing assistants (CNAs), licensed practical nurses (LPNs) and registered nurses
(RNs).
Empowerment.Conger and Kanungo (1988) defined empowerment in terms of a
relational dynamic: a process whereby an individuals belief in his or her self-efficacy is
enhanced (p. 474) through interaction with his or her leader.
Level 5 leadership.Jim Collins (2001) developed this description of leadership based on
a paradoxical blend of personal humility combined with professional will. This leadership style
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is intended to move organizations from being merely good to achieving sustained greatness, and
places emphasis on accountability and discipline.
Psychological empowerment.Spreitzer (1995) stated that it is a psychological state that
employees must experience for empowerment interventions to be successful. The four
components of this type of empowerment include meaning (congruence between job
requirements and beliefs); competence (confidence in ones own abilities); self-determination
(feelings of control over ones own work/autonomy) and impact (the sense of being able to
influence important outcomes within an organization).
Servant leadership.A leadership style conceptualized by Robert Greenleaf (1991) that
emphasizes 10 leader behaviors: listening, empathy, healing, awareness, persuasion,
conceptualization, foresight, stewardship, commitment to the growth of people, and building
community.
Structural empowerment.Kanter (1993) defined structural empowerment as access to
organizational structures that enable employees to accomplish their work in meaningful ways.
Specifically, Kanter listed access to formal and informal power, opportunity, information,
support and resources as the linchpins of structural empowerment.
Transformational leadership.The type of leadership that transforms individuals and,
consequently, their organizations. Transformational leadership, according to Bass and Avolio
(1993), rejects the status quo and fosters a culture of creative change and growth through the
empowerment and development of followers. The constructs of this model include: idealized
influence, inspirational motivation, intellectual stimulation and individualized consideration.
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Assumptions and Limitations
Assumptions made by the researcher included the expectation that accurate and truthful
answers to questions posed by the researcher were provided by interviewees and focus group
participants and that written documents provided by the provider organization were delivered in
their original form and not altered. Also, it was assumed that the sample of employees
interviewed were representative of other employees at the organization. Because a single case
study was the focus of this research, a limitation of the study is its generalizability to other aging
services provider organizations. Researcher bias is another limitation of the study. The researcher
has worked as a consultant to the field of aging services for 25 years. Hence, certain
preconceived notions exist due to familiarity with this field and provider organizations within the
field. The researcher took steps to mitigate this bias, including peer review, triangulation of data
and member checking strategies.
In addition, the researcher was mindful of the phenomenon discussed by Yin (1994)
regarding the danger of placing too much emphasis on a subunit of the embedded case study.
While one campus received more attention than the others due to its exceptionally low turnover
rate, the researcher visited three other campuses of the organization, and found that in two of the
three, culture change had taken root in a deep and systemic way.
Nature of the Study or Theoretical/Conceptual Framework
According to the Institute for the Future of Aging Services, the replacement cost of a
nursing assistant was $3,840 in 2001. Given that the typical aging services organization
experiences a 50% annual turnover rate, the industry cost to recruit and hire new staff to fill
vacant positions is estimated at $4 billion annually. Finding even a partial answer to the turnover
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rate issue and how to stem it would benefit the aging services field in a profound way by
lowering costs and achieving greater levels of efficiency. Hollinger-Smith, Holmes, OSullivan,
and Ortigara (2003) found significant improvements in nurse turnover rates after instituting a
program entitled Learn, Empower, Achieve and Produce, a culture change initiative that
reduced LPN and RN turnover by 20% and CNA turnover by 39% over a 1-year period of time.
This initiative emphasizes organizational learning and empowerment as two key foundational
elements.
Researchers suggest that the exorbitantly high turnover rates in aging services
organizations stem from the types of individuals attracted to the field. For example, Lescoe-Long
(1998) found that poor interpersonal skills and lack of mutual empathy among nurses aides and
their nurse supervisors affected communication, interfered with informal teamwork and were a
root cause for turnover for both aides and nurses. Training in interpersonal skills was
recommended for both nurses and aides as a result of this study.
The Kansas Association of Homes and Services for the Aging (2003) reported that a
sense of cynicism toward ones fellow human beings was evident among lower-level employees
in aging services organizations. These feelings are characteristic of people who have
experienced a great many hard times and disappointments. The cynicism suggests a lack of trust
of the motives of others and may well have affected participants willingness to fully embrace
the interventions teachings (p. 13). This finding reflects the belief that a certain percentage of
individuals coming into the field are by nature poor communicators, cynical, and untrusting of
others. Adding to this, there may be mistrust or miscommunication among the four generations
of workers that now populate the aging services workplace. These generations include
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Traditionalists, Baby Boomers, Gen Xers, and the Millennial Generation (Lancaster & Stillman,
2002).
The Institute for the Future of Aging Services (2003) conducted research concluding that
stress is overwhelming to people in the field of aging services, resulting in burnout, a prime
contributor to high turnover rates. The Institute noted in its report that there was high agreement
with these statements among those participating in its landmark turnover study:
I work under a great deal of stress.
I have too much work to do to do a good job.
I always feel I am racing from one thing to the next.
The people in my department are expected to do too much work.
The people in my department have more work to do than people in other departments.
In summary, the turnover rate in aging services could be due to any number of factors
including: a transactional culture that disempowers workers, poor leadership at the top and at the
supervisor level of the organizations, the untrusting and cynical nature of the individuals
employed by the field and/or burnout associated with stress experienced on the job. For the
purposes of this study, the researcher will focus on the relationship between leaders and their
followers, attempting to understand whether the dynamic of empowerment is present, and if so,
how this dynamic impacts the organizational culture. On the next page is a visual of the
conceptual framework for the study, outlining the variables that were initially examined by the
researcher.
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Figure 1. Researchers original conceptual framework.
Organization of the Remainder of the Study
Chapter 2 reviews the relevant literature and research impacting the study. Chapter 3
outlines the methodology employed in the study. Chapter 4 presents an analysis of the findings
of the research. Chapter 5 consists of conclusions as well as recommendations for future
research.
Empowerment:Access to organizational
structures that enable employeesto accomplish work in meaningful
ways.(Kanter, 1993)
Organizational Culture:Pattern of shared basicassumptions learned as
a group solves it problems ofexternal adaptation and internal
integration(Schein, 2004)
Leadership Style:Transformational
ServantLevel 5
Intervening variables:1. Nature of direct care
workforce: poorcommunicators, cynicaland untrusting.
2. Stress and staffingshortages, leading toburnout.
3. Generationaldifferences which causemisunderstandings.
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CHAPTER 2. REVIEW OF THE LITERATURE
A review of the literature was conducted to determine what is already known and what is
not yet known about the connection among leadership styles, empowerment and the development
of a culture in aging services provider organizations. The literature review also serves to assist
the researcher in the development and refinement of theory, as constant comparison with the
emerging data is expected to create new ideas and concepts. Since the relationship among
leadership style, empowerment, and culture is a multi-faceted and complex phenomenon, the
researcher will examine each of these dimensions in the literature review.
Rationale for the Research
The rationale for the research revolves around the importance of leadership styles that
empower workers so that organizational cultures support workforce retention in the field of
aging services. Scholars (Kanter, 1993; Manion, 2004; Taylor, 2004) posit that cultures of
retention are engendered primarily by leaders and the structural empowerment they create within
the organizations they lead. Uncovering the particular style of leadership and prominent
leadership characteristics is conducive to retaining desired talent in aging services organizations,
and eliciting the highest amount of creativity and innovation from this talent will be of vital
importance to the field in the coming decades.
The aging services field, which is predicted to achieve unprecedented levels of growth
and a much higher demand for direct care personnel over the next 20 years, has seen the
introduction of numerous person-centered culture models recently, including Wellspring,
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Greenhouse Project, Eden Alternative, and the Pioneer Network Model. Yet, it is widely known
that nurses in all healthcare fields are leaving (Laschinger et al., 2003) with an average annual
turnover rate hovering at 50% and a persistent 5% vacancy rate. It costs $4 billion annually in
recruitment and training expense just to keep enough nurses on the floor of long-term care
facilities. With the time and costs of maintaining the status quo, little emphasis is placed
leadership development. Yet without it, culture initiatives will fail. Most aging services
communities continue to operate under a transactional leadership model, despite evidence that
direct care givers respond more favorably to a transformational leadership style (Thyer, 2003).
In the report Who Will Care For Us?(Stone & Wiener, 2001), it is noted that in the
1980s several small, qualitative studies of nursing assistants identified the organizations
management style (e.g., supervisors with good people skills, promotion of worker autonomy) as
the most important predictor of higher job satisfaction and lower turnover rates (p. 5). Another
study (Konrad, 1999) found that when nurse supervisors accepted nursing assistants advice or
simply discussed care plans with the aides, turnover rates dropped by a third. These findings
strongly point to the positive effect of empowerment in the aging services workplace. The
rationale for the proposed research, then, is to understand howleadership is connected to
empowerment and whether other leader characteristics facilitate cultures that encourage workers
to stay in the aging services workplace.
Theory Generating the Question and Exploring the Foundations of the Field
The primary research question to be explored in this study is: Can a culture change, with
an emphasis on retention, be created by a certain type of leadership style in aging services
organizations? And if so, what are the specific behaviors and characteristics associated with such
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a leadership style? The question touches upon empowerment theory, leadership theory, and
culture change theory, and requires a deep familiarization with each theme area.
Theme Area 1: Empowerment Theory
The concept of empowerment has been widely adopted in nursing research (Kuokkanen,
Leino-Kilpi, & Katajisto, 2003) as a strategy for attracting young people and retaining nurses
currently working in the healthcare fields. Within the nursing field, Kanters (1977, 1993)
empowerment theory has been used as a basis for research to understand how this concept
influences organizational trust, job satisfaction and organizational commitment. Kanter (1993)
posited that access to information, support, resources and the opportunity to learn and develop
are empowering to nurses, influencing their work attitudes and productivity. Kanters notion of
structural empowerment is based on the idea that workplace environments and leadership style
have a greater impact on employee attitudes and behaviors than personal predispositions
(Laschinger & Finegan, 2005, p. 6).
Several studies of nurses have linked structural empowerment to factors identified as
important for retaining nurses (Kutzcher, Saviston, Laschinger, & Nish, 1997; Laschinger,
Almost, & Tuer-Hodes, 2003; Whyte, 1995). Wilson and Laschingers (1994) work concluded
that administrators in healthcare settings can empower their staff and thus improve
organizational commitment by manipulating the structures in the work environment to allow
greater access to the power and opportunity structures that Kanter (1977) maintains are important
to overall work effectiveness. More recent research by Laschinger and Finegan (2005)
concluded: Work settings which are structurally empowering are more likely to have
management practices that increase employees feelings of organizational justice, respect and
trust in management (p. 7). Manojlovich (2005) studied the interaction between structural
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empowerment, leadership and self-efficacy for nursing practice to determine if self-efficacy
contributes to more professional nursing behaviors. The researcher argued that opportunities for
role modeling and verbal persuasion did improve practice behaviors as well as job satisfaction.
Barry, Brannon, and Mor (2005) used an adaptation of Kanters theory of structural
empowerment to guide the framework for their study on nurse aide empowerment strategies and
found it led to nurse aid staff stability. Kane-Urrabazos (2006) study of managements role in
shaping organizational culture led the researcher to determine that leaders influence in creating
positive workplace environments can increase employee satisfaction, impacting turnover rates
positively. Identified in this study were four critical components of a culture conducive to
retaining workers: trust, empowerment, consistency and mentorship. However, Spreitzer (1985)
found that employees must possess psychological empowerment, a psychological state that
allows empowerment interventions to be successful.
Empowerment, at both the structural and psychological levels, has been linked through
previous studies to culture change. Conger and Kanungo (1988) wrote: Empowerment may
prove to be a vital form of influence for leaders attempting to induce and manage organizational
culture change (p. 480). One purpose of the research proposed is to identify whether
empowerment exists at the provider organization being studied, and if so, how it is defined by
direct care workers and their supervisors.
Theme Area 2: Leadership Style Theory
Northouse (2004) lists more than 35 identifiable styles of leadership developed by
scholars over the past 50 years. The more recent styles emphasize relationship over task and are
based on the belief that leaders are not born, but rather have the ability to learn relationship skills
(p. 3). Three of the most prominent and popular affective leadership styles today are
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transformational leadership, servant leadership and Level 5 leadership, all belonging to the New
Leadership paradigm originally identified by Bryman (1992). The New Leadership paradigm
favors leadership styles that focus on relationship-building between leaders and their followers,
requiring an emotional involvement that did not typify earlier leadership styles, such as those
based on the Great Event or trait approach theories.
Transformational Leadership
Transformational leadership, first introduced by Burns (1978) and later conceptualized by
Bass and Avolio (1990), consists of four constructs known as the Four Is: idealized influence,
inspirational motivation, intellectual stimulation and individualized consideration. These
constructs, when actualized in behaviors by the leader, are believed to contribute to followers
self efficacy and, in turn, help them connect more deeply to the organizational mission and
vision. Through this connection, the follower is able to achieve more than originally thought
possible and is motivated to help transform the organization to greater heights.
Tichy and DeVanna (1990), in their study of transformational leaders, identified the
specific elements that cause an organization to journey from the status quo to transformation.
The core element is the need for the leader to help followers recognize the need for
change. This typically is accomplished by pointing out to followers how changes in external
forces could positively or negatively affect the organizations future. Leaders encourage dissent
and argument to question the organizations basic assumptions, at times playing the role of
devils advocate to encourage alternate ways of seeing the same problem. Another technique
involves the use of objective assessment to determine whether the organization is meeting its
established goals and to identify the best practices employed by other organizations. By shifting
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the basic paradigm of the organization from the status quo to how can we be better? the leader
acts as change agent.
The next phase of the change process is vision creation. While the leader begins with an
overall concept of what the organizational vision can be, followers are encouraged to participate
in developing a conceptual roadmap of what the organizations future will look like.
Following this phase comes the process of breaking down old structures and establishing
new ones. It is during this phase that transformational leaders often put in place new coalitions of
employees compatible with the new vision. A key element of these teams is empowerment,
which involves power-sharing between leaders and followers, and is characterized by
independent decision-making on the part of subordinates. Shamir, Zakay, Breinin, and Popper
(1998) suggested that by having high expectations of followers and showing how the
organization has confidence in their abilities, transformational leaders are instrumental in
positively impacting worker self-esteem. This self-esteem, in turn, contributes to organizational
learning because employees feel more freedom to experiment and make mistakes. In allowing
the followers creativity and innovative ideas to blossom, the transformational leader encourages
them to feel ownership of the vision as well as the organization as a whole. By empowering
followers to find new ways of approaching old problems and welcoming opposing points of
view, the transformational leader ingenerates feelings of trust and tolerance (Avolio & Gibbons,
1988). This infrastructure allows for the organizational seismic shift that is required for
organizational culture change to take place. The movement takes place at three levels
individually, structurally and climatically (Lewin, 1948).
The final stage of the cultural transformation is refreezing the organization so that the
institution of new patterns of individual behaviors, systems and climate occurs. For example, the
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refreezing process could result in new recruitment practices to ensure individuals hired within
the organization are open and receptive to change. It might also involve the adoption of a new
reward system for employees who exhibit desirable operating norms at the structural level.
Climatically, the changed organization may adopt a new vision that emphasizes participative and
open management styles. Such transformations require commitment and courage on the part of
the leadership.
The four constructs of the transformational leadership model as conceptualized by Bass
and Avolio (1990) each play a part in helping the leader to transform the organization. While
transactional leaders work within the existing culture of an organization, transformational leaders
reject the status quo, fostering a culture of creative change and growth through the empowerment
and development of their followers.
According to Bass and Avolio (1993), the characteristics and qualities of an
organizations culture are taught by its leadership and eventually adopted by its followers (p.
113). The transmission of a new culture occurs through specific leadership behaviors, namely the
Four Is of transformational leadership (Avolio, Waldman, & Yammarino, 1991).
In a transformational culture, a general sense of purpose is articulated by a strong mission
statement. In addition, theidealized influence construct of the model emphasizes the importance
of role-modeling by the organizations leaders. This role-modeling helps socialize new members
into the culture by demonstrating high standards of virtuous behavior. The organization is guided
by a compelling vision, which is strongly articulated by the leadership, but is also strongly felt
and owned by the organizations followership. Vision is central to the transformational leaders
work because it mobilizes followers to set goals and achieve them. The vision not only
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articulates the organizations future direction, but also clarifies the organizations identity and
how individuals fit within its context.
By providing a sense of meaning and connecting an individual workers role to the
overall vision of the organization, the transformational leader motivates followers. This
inspirational motivationprovided by the transformational leader causes followers to believe they
have a significant part to play in achieving the vision. It compels followers to optimize their
abilities and contributions. In contrast, the transactional leader is focused on contingent reward
and management by exception that does little to motivate workers to be all they can be for
their own development and the good of the organization. Therefore, workers in a transactional-
based working environment are motivated not by a compelling vision but rather by rewards,
whether they be monetary or in some other form of exchange. Commitments in such an
environment are short-lived and each worker is more concerned with his or her own day-to-day
tasks than the larger picture of the organization. Employees in the transactional environment
work independently and cooperation is dependent upon negotiation. Therefore, little
identification exists with the mission or the vision, and leaders are seen as little more than
brokers of resources. Flexibility, discretionary behavior or creativity is rarely found in a highly-
transactional environment, and the culture rarely changes. Although transactional cultures are
focused on maintaining or achieving acceptable standards of performance, the modus operandi is
to sustain the status quo, not to challenge it.
Transformational leaders who employ inspirational motivation, on the other hand, are
very intent upon providing challenge to workers. According to Avolio, Waldman and
Yammarino (1991), transformational leaders strongly support a lifespan model of self-
development and development of others and thrive on and seek out challenges throughout life
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(p. 12). This challenge-seeking psychographic dimension of leadership explains why
transformational leaders are successful in drawing others to them who are also challenge-driven
and willing to take intellectual risks. To transform others, the leader accepts and recognizes the
need to first transform herself. When others see this willingness on the part of the leader, they are
more inclined in turn to grow and develop. Part of this willingness involves risk-taking and
challenge-seeking. In fact, research has demonstrated that transformational leadership can be
developed at the lower levels of an organization when those individuals are exposed to the
behaviors of transactional leaders at the higher levels (Bass, Waldman, Avolio, & Bebb, 1987).
Intellectual stimulationis another aspect of the transformational leadership model that
fuels organizational culture change. As mentioned earlier, organizational learning is a key
component of this construct. Leaders who intellectually stimulate others cause followers to re-
examine their basic assumptions and change the way they think about problems, both technical
and human resource-related. An intellectually-stimulating leader encourages followers to look at
issues with a new lens and is willing to challenge his or her own previously-held assumptions
when workers bring new information and ideas to the leader. As a result of being intellectually
stimulated, followers develop their own ability to creatively problem-solve over time, causing
the very culture of the organization to become more open, flexible, and innovative.
The individualized considerationconstruct of the transformational leadership model
recognizes the need to treat each individual employee as a unique and valued being. Leaders
employing this characteristic listen to and share followers concerns while assisting with
confidence-building. By acknowledging and responding to individual worker needs,
transformational leaders garner the resources necessary to help individuals succeed and thrive in
the workplace, removing roadblocks to success and serving as advocates when required. By
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nurturing their followers, leaders are able to help them achieve their optimum potential, which in
turn contributes to the overall change in culture of the organization. Followers become more
transformational themselves, because their needs are being met and they are now able to focus
more fully on the needs of their own subordinates. The process is best characterized as leaders
developing leaders, according to Avolio et al. (1991, p. 15).
Through employment of the Four Is, transformational leaders realign the values and
norms of their organizations while promoting internal and external change. Through role
modeling, visioning, challenging and intellectually stimulating followers, such leaders are able to
inspire others to change themselves, and thus change the organization. Schneider, Brief, and
Guzzo (1996) state that organizations as we know them are the people in them; if people do not
change, there is no organizational change (p. 7). Transformational leaders develop relationships
with followers so that they feel nurtured and valued, creating a safe environment conducive to
personal and corporate levels of change and growth. Bennis and Townsend (1995) refer to this
phenomenon as ACE: acknowledge, create and empower.
Tichy and Ulrich (1984) stated that transformational leaders create something new out of
something old and that their followers are taught to learn from the past instead of lamenting over
previous mistakes. They begin to act out fresh scripts instead of stale ones, freeing their creative
juices. In essence, it is this teaching that allows followers to embrace the change their leaders ask
them to embrace. Therefore, the connection that bridges transformational leaders and culture
change is empowerment through organizational learning: the ability of the leader to teach
individuals how to change themselves, using the leader as role model and supporter of the
change process. As posited by Tichy and Ulrich (1984): The transformational leader needs to
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articulate new values and norms and then to use multiple change levers ranging from role
modeling, symbolic acts, creation of rituals to support new cultural messages (p. 67).
Each of the constructs of the transformational leadership model supports this notion of
the leader as teacher, whether in the form of role model, vision articulator, motivator, interpreter,
mentor, coach, intellectual stimulator or empowering nurturer. Bryant (2003) states that the
transformational leader is more effective in creating and sharing knowledge at both the
individual and organizational levels than are more traditional leaders. Because leaders provide
the context in which workers create knowledge and determine how work is valued within the
organization, they influence worker motivation to develop new knowledge. By creating a climate
receptive to new ideas, transformational leaders open the gates of change.
Servant Leadership
Servant leadership is often referred to as values-based leadership and places a high
premium on ethics and authentic behaviors. Introduced by Greenleaf (1991), servant leadership
is a style emphasizing teamwork, community, democracy and humanism. The 10 key
characteristics are associated with this leadership style are: listening, empathy, healing,
awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of
people, and building community (Spears & Lawrence, 2004).
Listening pertains not only to listening to the voice of followers, but also to the internal
voice of the leader himself or herself. Listening is an essential part of communication. It is
estimated that 45% of organizational energy is dissipated due to misunderstandings between
supervisors and their subordinates, with two out of every three mistakes occurring due to
miscommunication (DeGraaf et al., 2004).
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Empathy is the capacity for understanding another individuals ideas or feelings. Albrecht
and Zemke (1985) refer to empathy as moments of truth that enhance relationships between
supervisors and their subordinates as well as employees and their customers.
The spiritual dimension of servant leadership is manifested in the healing characteristic.
As problems and crises occur in the lives of employees, leaders are called upon to take an active
role in helping their subordinates heal their wounds and become whole once again through the
encouragement of the leader. They understand that their key task is to create and maintain a
positive environment in which people are motivated to work, according to DeGraaf et al.
(2004).
Awareness is the leadership characteristic that calls for regular self-reflection, as well as a
knowledge of the needs of those who the leader serves. Covey (1989) emphasized the
importance of self-examination and of keeping the end in mind. By this he means it is critical to
know what values the leader holds as important, so that decision-making can more readily
happen. Alignment between the leaders own values and the content of decisions made is of
paramount importance.
Persuasion, used appropriately and not in a coercive manner, is another dimension of
servant leadership. The concept of persuading others within this context relates to
communicating the value of a product or service to others so that they understand clearly how it
will benefit their lives (DeGraaf et al., 2004).
Conceptualization is related to the systems-thinking construct found in Senges (1990)
organizational learning model. The ability to view phenomenon holistically, seeing the forest
through the trees, and inductive reasoning are embedded in conceptualization.
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Foresight, a close cousin of conceptualization, is the ability to know where to head next.
Leaders must be sensemakers and visionaries for their organizations, but do so within the context
of empowermentand teamwork as co-creators of the future (DeGraaf et al., 1994, p. 151).
Accountability and shared power are the underlying constructs of stewardship, as
envisioned by Greenleaf (1991). Stewardship is not limited to, but includes, an association with
the environment and financial responsibility. Block (1996) referred to stewardship as the orderly
distribution of power. The concept is tied to empowermentand trust.
Commitment to growth of people is another hallmark of servant leadership, as it
underscores the importance of mentoring and intellectually stimulating others. Building
community, the tenth and final characteristic identified as crucial to servant leadership, is tied to
social accountability and the need for leaders and their organizations to be mindful of the needs
of their communities. Enhancing the quality of life for both employees, customers and the greater
society is a focus of community-building (Greenleaf, 1991).
Level 5 Leadership
Level 5 leadership as conceptualized by Collins (2001) is described as a skillful blend of
professional will and personal humility. Self-effacing, quiet, reserved, shythese leaders lead
their organizations from good to great through a fierce resolve to channel their energy into the
vision, not into their own egos. Collins (2001) wrote: Given that Level 5 leadership cuts against
the grain of conventional wisdom, especially the belief that we need larger than life saviors with
big personalities to transform companies, it is important to note that Level 5 is an empirical
finding, not an ideological one (p. 22).
Collins (2001) work heavily promotes the notion of empowerment, advocating that
leaders should build a culture around the idea of freedom and responsibility (p. 124). However,
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unlike the transformational and servant leadership models, Collins conceptualization is that
empowerment strategies will not be successful unless the right people are employed by the
organization. In other words, those who lack internal motivation will likely not change even if
they are empowered by their leaders. He maintains that once these intrinsically motivated
workers are engaged in work they are passionate about with co-workers and leaders who earn
their respect, the employees will thrive in their workplaces and take their organizations to
greatness. Collins (2001) notion of intrinsic motivation dovetails with Spreitzers (1995)
concept of psychological empowerment, a psychological state that employees must experience
for empowerment interventions to be successful.
The three leadership styles of transformational, servant and Level 5 have strong
theoretical underpinnings related to empowerment and culture change. The purpose of the
research was to explore the leadership style of the CEO and management team at a provider
organization and examine whether the characteristics identified have a relationship to
organizational transformation.
Theme Area 3: Organizational Culture Change
The definition of culture is somewhat elusive, according to Lewis (1994). There is no
consensus of opinion about what organizational culture really is, a problem that occurs when a
term is borrowed from another discipline. Culture originated in the field of anthropology
(Meek, 1988). Some authors see culture as intangible shared meanings and basic assumptions.
Others, like Lewis (1994), define culture as the feelings, beliefs, values and basic assumptions
held by members of the organization, either collectively or individually, as they relate to work
activities (p. 43). Allaire and Firsirotu (1984) state that how individuals view organizational
culture will determine how one studies it. In fact, Schein (1992) found that ones view of culture
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also determines how a leader goes about changing it. Thus, different researchers posit different
ways to change the culture of an organization.
Kurt Lewin (1948), a pioneer in the field of social psychology of organizations, identified
three phases of change: unfreezing, moving, andrefreezing. According to Lewins change model,
organizations are like living creatures; that is, they tend to be homeostatic, or continuously
working to maintain a steady state. This open-systems view helps explain why organizations
require external impetus to initiate change and why that change will be resisted even when it is
necessary (Goodstein & Burke, 1991). According to Goodstein and Burke (1991), organizational
change occurs at three levelswithin individuals who work at an organization, through
organizational structures or systems, and through the organizational climate or interpersonal style
of interaction among employees (p. 10).
Lewin (1948) believed that the first step of any culture change process is to first unfreeze
the present pattern of behavior as a way of managing resistance to change. Depending on the
organizational level of change required, this unfreezing process may involve anything from the
selection of new organizational leadership to the termination of resistant employees. At the
structural or systemic level, the unfreezing may involve the development of new organizational
designs such as matrix management. At the organizational climate level, it could involve the
adoption of a learning environment whereby dialogue and other techniques are utilized (Issacs,
1993).
The second stage of Lewins model is movement, which consists of making the actual
changes required to impact a new culture. For example, at the individual level, this may mean the
adoption of new supervisory interaction techniques. Structurally, a new performance appraisal
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system could be put into place. Climatically, new levels of trust and openness could be
encouraged by management with employee groups.
The final stage of the culture change process, refreezing,involves stabilization or
institution of the new patterns of individual behaviors, systems and climate. For instance, the
refreezing process could manifest itself in new recruitment practices to ensure individuals hired
in the future are open and receptive to change; the adoption of a new reward system for
employees who exhibit certain operating norms and a vision that emphasizes participative and
open management styles.
Goodstein and Burke (1991) posited: Changing behavior at both individual and
organizational levels means inhibiting habitual responses and producing new responses that feel
awkward and unfamiliar to those involved. It is all too easy to slip back to the familiar and
comfortable (p. 14). The culture change process, then, typically requires courage and
commitment of top management. Goodstein and Burke (1991) concluded that an understanding
of social psychology of the change process is implicit to success.
Schneider et al. (1996) posited that different leadership styles create certain types of
social climates that affect productivity in specific ways. People are nearly equally productive
under democratic and authoritarian leadership styles, but they work much more harmoniously
and are more satisfied under a democratic leader (p. 9). These authors differentiated between
organizational climate and organizational culture, terms frequently used interchangeably in the
culture literature, by stating because organizational culture concerns the firmly implanted
beliefs and values of organizational members, it resides at a deeper level of peoples psychology
than does climate. Culture captures a less conscious, more subtle, psychology of the workplace.
Whereas climates policies, practices and rewards are observable, the beliefs and values of
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culture are not so directly visible (p. 11). However, they also argued that culture can be changed
through a focus on climate because climate reflects the tangibles that produce a culture. It is only
by altering the everyday policies, practices, procedures and routines that change can occur and be
sustained. Schneider et al. (1996) stated: To communicate new values and beliefs requires
changing tangibles, the thousands of things that define climate, that define daily life in an
organization. Deeds, not words, are tangible (p. 12).
The organizational development perspective, which relies heavily on the works of
Abraham Maslow (1943), rests on a number of assumptions about people and their relationships
in organizations, namely: (a) people desire growth and development, (b) people value
interpersonal interaction, and (c) people need trust, support and cooperation to function
effectively. Research suggests that organizations, when they learn to operate under such
assumptions, are more open to change (Schneider et al., 1996).
To successfully change an organization, the top management team must move the
respective parts of the organization in accordance with the change, but must also model a new
climate. For example, the team may begin communicating differently and sharing resources more
freely with one another. A top management teams success in delivering sustained
improvements through system-wide change in climate and culture greatly depends on that teams
ability to arrive at a shared vision and to be uniform in its commitment (p. 18) wrote Schneider
et al. (1996).
The transformation of a company requires employees to adopt a new view of its future, a
future they need to regard as essential. Before employees can arrive at this deep conviction,
stated Day and Jung (2000), they need to understand why? and why now? requiring the skill
of a leader able to communicate those answers.
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Klein (1996) believed this type of communication skill is the primary need leaders must
address during the unfreezing stage of organizational change so that people are readied for
change (p. 37). During the unfreezing stage, the content of the communications is characterized
by explanation, rationales and reassurances states Klein (1996, p. 38). If the change is more
than marginally incremental, it is likely that the resistance, some of it strong, will surface
because old values and methods are implicitly challenged. It is because the level of resistance is
so high, that strong communication skill is required at this stage of the change process. If the
change is organization-wide, Young and Post (1993) recommended that the CEO be the main
communicator.
Jick (1995) advised that the change process takes considerable patience, stating that
changing a company and its culture can take up to seven years or longer. The challenge involves
changing the hearts, minds and habits of people, the so-called software of a company, he
wrote (p. 79). No culture change occurs without people learning new ways of behaving and
thinking. The change begins, by first changing the leader, through leadership role modeling. Jick
(1995) emphasized the need for the leader to walk the talk and display behavioral integrity
through the consistency between the walk and the talk. He further maintained that accelerating a
change process requires skill, determination and creativity. Challenging accepted paradigms of
how change is introduced and managed is also required.
Kotter (1995) clarifies the connection between culture change and leadership even more
specifically when he stated: change, by definition, requires creating a new system, which in
turn, always demands leadership (p. 60). Transformations often begin when an organization has
a new leader who sees the need for a major change and questions the status quo. Kotter (1995)
emphasized the need for powerful vision creation and communication, encouragement of risk
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taking, and non-traditional ideas, activities and actions. He also underscored the importance of
creating a coalition of believers in the need for change. Kotter (1995) additionally observed that
in failed transformations, there was evidence of plans, directives and programs, but no vision. He
added that employees will not make sacrifices, even if they are unhappy with the status quo,
unless they believethat useful change is possible. Therefore, the presence of a strong leader is
key to culture change.
Bartlett and Ghoshal (1990) explained that in the past, companies often assumed that
changing their formal structure would force change in interpersonal relationships and decision
processes, which in turn would reshape the individual attitudes and actions of managers. Today,
the impracticality of such an approach is acknowledged due to the long time span that is required
for structural changes to permeate the whole spectrum of organizational features. An alternative
starting point is to alter the broad corporate beliefs and norms that shape managers perceptions
and actions through visioning, utilization of human resource tools, and stimulation of individual
participation and thinking within the broad corporate agenda. There is also acknowledgement,
according to Jick and Peiperl (2003), of the importance of a networked organization to cultural
change. The networked organization is a concept not about formal structure, but rather about
how to put different parts of the organization and its workers in touch with each other, free of
boundaries.
Cultures of Retention in Aging Services
Laschinger and Finegan (2005) stated that an important strategy for increasing
recruitment and retention of nurses will be to create work environments that manifest justice,
trust, and respect and thereby facilitate professional nursing practice (p. 6). Manion (2004)
described a culture of retention as a workplace where people want to be (p. 39) and posited
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that organizational leadership plays a dominant role in the culture and climate of the workplace.
Thyer (2003) boldly claimed that transactional leadership styles are causing nurses to leave their
places of employment. Ideologically, she claims, nurses require a working environment led by
those who are visionary and creative, not lock-step and disempowering. Because nurses and
direct care staff comprise a significant portion of the aging services workforce, those in direct
care job positions influence the entire system of an aging services organization. Yeatts and
Seward (2000) suggested that the use of self managed work teams could reduce turnover and
improve care in nursing homes. Naude (1995) found that transformational leadership had a
positive impact with nursing unit managers in a Western Australia aged care service
organization, leading to lower turnover rates. Taylor (2004) posited:
Responsibility and accountability for retaining talent need to move out to the front linesand into the hands of leaders. Leaders and their skill in building a climate of retention, aculture that speaks to employees in a way that encourages them to stay, will be anorganizations best defense against unwanted turnover. Leaders are the secret weapon inkeeping valued talent longer. (p. 43)
The purpose of the research was to identify the current culture of the provider
organization and determine how this culture has evolved since the time the new CEO and
management team has been in place. Specifically, the study explores the relationships among
leadership style, empowerment and culture.
Summary
Leadership styles are much debated in the management literature and have been studied
using both qualitative and quantitative methods in many contexts (Northouse, 2004, p. 1).
Bryman (1992) introduced the New Leadership paradigm, which emphasized the relationship
between leaders and followers, suggesting that the affective elements of leadership could be
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successful in motivating followers. These affective elements include good communication, a
concern for the individual and his or her unique needs and qualities, and serving as a positive and
ethical role model for followers. Three prominent leadership styles emphasizing these elements
are transformational leadership, servant leadership and Level 5 leadership (Popper, 2005).
Within the aging services field, high turnover rates threaten the ability of providers to
serve an ever-growing population of seniors. Turnover, studied by numerous nursing and aging
scholars, is due to a variety of factors, including a transactional-type work environment that is
authoritative and bureaucratic in nature, placing little emphasis on relationships between
employees and their leaders. Empowerment is a central element of transformational, servant and
Level 5 leadership styles. However, little research has been conducted to determine the exact
behaviors and leadership style most conducive to creating empowerment, which Kanter (1993)
describes as a strategy that enables employees to accomplish their work in meaningful ways.
Through empowerment, leading nursing scholars (Kanter, 1993; Laschinger et al., 2003)
posit that cultures of retention (Manion, 2004) can be created in healthcare organizations.
These cultures are work environments where employees want to stay; they are cultures where
engagement and contribution occur.
The majority of research conducted to date on these topics strongly suggests that leaders
impact the ability of an organization to possess a culture of retention. However, in the field of
aging services, no research has been carried out to specifically uncover the type of leadership
style required for a culture of retention to exist and flourish.
As the population of seniors grows in the United States, so does the need for direct care
workers to provide care to those requiring it. A severe shortage of direct care workers already
exists and this shortage is expected to grow exponentially over the next decade. To attract
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workers to the field of aging services, provider organizations are implementing a number of
strategies, including the hiring of foreign-born nurses, allowing employees to work more flexible
hours and developing cultures of retention (Manion, 2004). These cultures are ones where
structural empowerment exists and enable employees to accomplish their work in meaningful
ways (Kanter, 1977). While the link between culture and empowerment has been established
through previous research studies (Eaton, 2001; Laschinger & Finegan, 2005; Stone & Weiner,
2001; Taylor, 2004), it is yet not clear what kind of leadership style is most conducive to
empowering employees so that a culture of retention is created in aging services environments.
Identifying a full-range of leadership characteristics that contribute to the creation of cultures
that encourage workers to stay in these environments will have significant impact on the field,
contributing to its financial health and its public image.
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CHAPTER 3. METHODOLOGY
Purpose of the Study
The research study employed a case study approach to better understand the relationships
among leadership style, empowerment and culture change. The case study focused on an aging
services provider organization based in the United States, where a leader and management team
from outside the field was brought into effect culture change.
Researchers Philosophy and Knowledge Claims
Case study is an ideal methodology when a holistic, in-depth investigation is needed
(Feagin, Orum, & Sjoberg, 1991). Case studies bring out details from the viewpoint of
participants by using multiple sources of data (Tellis, 1997). Although all forms of qualitative
research have the potential to contribute to theory-building, Eisenhardt (1989) made a cogent
argument that case study is ideally suited for this type of knowledge creation. Like Jick (1979),
she posited that triangulation, with its multiple sources of data, allows for a more robust
substantiation of constructs and hypotheses (Eisenhardt, 1989). Because case study emphasizes
detailed contextual analysis of a limited number of events, conditions and their inter-
relationships, it is useful in providing the application of ideas to the real world. Yin (1984) wrote
that case study is especially useful when the boundaries between phenomenon and context are
not clearly evident (p. 23).
Critics, on the other hand, claim that case study offers no grounds for establishing
generality of findings because of the small number of cas