Post on 20-Apr-2023
CHAPTER ONE
INTRODUCTION
1.0 Background
For healthcare organizations good leadership is more than just
important. It is absolutely critical because of the type of success
that they seek. The primary goal of any healthcare organization is to
provide high-quality safe care to patients whilst maintaining
financial sustainability, community service and ethical business
behaviour. Good leadership could be the main ingredient for achieving
this goal. It is appropriate to study leadership styles in hospital
settings especially against the backdrop of the mounting pressures for
quality care, both locally and internationally. The fact that
hospitals are increasingly called upon to provide quality care amidst
cost reduction and a myriad of other problems militating against the
minimum standards of health care delivery causes considerable stress
for employees. When stress is a person’s emotional response to his or
her job condition, then job satisfaction clearly becomes poor and
aggravated. Grossman and Valiga (2000, pp. 4) agree that the most
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likely panacea for such a situation is motivational, challenging and
inspiring leadership.
The connection between leadership and job satisfaction can have far-
reaching consequences. In the best of scenarios, managers and other
leaders within the hospital structure may inspire employees to take
pride in their work and also feel competent in the tasks they are
assigned. This, in addition to a number of other different strategies,
will help to create a working situation that enhances the satisfaction
of employees in general and their job satisfaction in particular.
Ultimately, the hospital will enjoy a higher level of productivity, a
lower extent of turnover and a more stable and appealing working
environment.
The role of leadership in hospital settings as a key factor in
employee job satisfaction has been explored by several investigators.
Nakata and Saylor (1994) found that leadership style in the hospital
setting has significant effects on productivity and efficiency, and
reflects on patient outcomes. (Moss & Rowles, 1997) also found that
increased job satisfaction is one key factor that improves quality
outcomes, patient satisfaction, and employee retention in hospitals.
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The American Nurses’ Association (ANA) sponsored a study in 1982 as to
which hospitals were successful in professional nurse retention and in
giving good nursing care and reputable as good places to work. The
study revealed forty-one hospitals across the United States as having
these qualities and called them “magnet” hospitals (Kramer, 1990).
Kramer and Schmalenberg (1991) later showed that the success of the
magnet hospitals was partly attributable to their use of hospital
leadership characteristics as a means of promoting job satisfaction
and retaining staff. The purpose of this study was to examine the
relationship between perceived leadership styles and staff job
satisfaction in private hospitals in the Sunyani Municipality in
Ghana.
1.1 Statement of the Problem
The problem of focus in this study is the relationship between
leadership style and its consequences for job satisfaction in private
hospitals in the Sunyani Municipality. Ghana, like many developing
countries, lacks adequate resources to motivate and retain its health
workers (Sanders, Dovlo, Meeus & Lehmann, 2003). Poor job
satisfaction and low morale are endemic among public healthcare
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professionals in the country (Bloom & Standing, 2001). Available
analysis on public sector health workers argue that the lack of
adequate remuneration is the main health worker grievance in low
income countries, and this seems to be the main reason why public
sector health workers are frequently missing or working elsewhere
(Global Equity Initiative, 2004).
Bloom & Standing (2001) found that an inability to afford the basic
necessities of life is among the common reasons for job
dissatisfaction in Africa as a whole. In a study on the key
determinants of migration among health professionals in Ghana, Anarfi,
Quartey and Agyei (2010) found that 63% of workers in the health
sector were unable to make ends meet from their monthly incomes. From
an interviewer-administered questionnaire, Agyapong, Anarfi, Asiamah,
Ansah, Ashon and Narh-Dometey (2004) also found that in Ghana, health
workers overwhelmingly identified low salaries as the main source of
job dissatisfaction. Job satisfaction, especially in the healthcare
sector, has thus been invariably tied to financial incentives
(Chernichovsky & Bayulken, 1995; Eichler, 2006; WHO, 2006).
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Nonetheless, the prominence of non-financial motivating factors such
as leadership makes it difficult to argue that financial incentives
alone significantly improves health worker motivation and job
satisfaction. Other studies in Africa and elsewhere (Gray, 1991;
Tumulty, Jernigan & Kohut, 1995; Rantz, Scott & Porter, 1996; Manongi,
Marchant & Bygbjerg, 2006; Mathauer & Imhoff, 2006; WHO, 2006) have
shown that paying health workers well and on time alone does not
guarantee job satisfaction. In fact well-intentioned efforts to
improve financial incentives for health workers can actually undermine
morale and lead to negative consequences for health workers if they
are not combined with good leadership (Dudley, 2005). The World Health
Report 2006 observes that better leadership is a non-financial
motivator which contributes to increasing health workers' self-
perception of being able to do a good job and fulfill their duties
(WHO, 2006). Several studies have equally demonstrated that
leadership style, particularly transformational, can be beneficial to
workers' mental health and job satisfaction (Yukl, 2005).
The private healthcare sector, a fairly new development in the
country, typically operates on a for-profit basis and therefore
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maintains facilities that are generally well staffed and have a good
supply of drugs and equipment. Healthcare facilities in the private
sector offer competitive salaries and other fringe benefits and have
in fact been attracting health professionals from the public sector.
What is the level of job satisfaction among private sector healthcare
workers in Ghana? Apart from the financial incentives and available
equipment and drugs, does leadership style play any significant role
in the job satisfaction levels in private sector healthcare
facilities?
What styles of leadership are practised in private hospitals in the
Sunyani Municipality? Does the leadership style explain, in any way,
the job satisfaction levels of staff in these private hospitals? The
relationship between job satisfaction and the leadership styles of
hospital executives was the problem for this study. By studying and
implementing effective leadership styles conducive to productivity,
efficiency, and job satisfaction, the quality of patient care within
the hospital system can be enhanced.
1.2 Research Objectives
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The study set out to achieve the following specific objectives:
1. To examine the job satisfaction levels of workers in private
hospitals in the Sunyani Municipality
2. To examine the leadership styles of mangers of private hospitals
in the Sunyani Municipality in Ghana
3. To find out the relationship between leadership styles and job
satisfaction in private hospitals in the Sunyani Municipality
4. To find out which dimension of leadership has the strongest
positive association with job satisfaction in the hospitals
1.3 Research Questions
The research questions whose answers guided the study towards
achieving these objectives were:
1. What is the level of job satisfaction among private sector
healthcare workers in Ghana?
2. In the private hospitals of the Sunyani Municipality in Ghana,
what styles of leadership do the workers perceive their
management as practising?
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3. Is there any relationship between the leadership styles and job
satisfaction of the workers?
4. Which dimension of the leadership practised by managers of the
hospitals has the strongest positive association with job
satisfaction?
1.4 Hypotheses
The hypotheses tested to find answers to the above research questions
were:
1. Majority of the workers of private hospitals in the Sunyani
Municipality are satisfied in their jobs
2. Managers of private hospitals in the Sunyani Municipality
practice the transformational style of leadership.
3. There is a significant association between leadership styles of
managers of private hospitals in the Sunyani municipality and job
satisfaction workers derive.
4. The ‘Individualized Consideration’ dimension of Transformational
leadership has the strongest positive association with job
satisfaction in private hospitals of the Sunyani Municipality.
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1.5 Overview of Research Methodology
This study was designed as a correlational research. A simple random
sample of 80 respondents meeting the inclusion criteria for the study
was obtained from 8 private hospitals in the Sunyani Municipality.
Respondents were selected based on being a clinical or non-clinical
worker assigned to a non-supervisory, staff position in the hospital
and working under the direct supervision of a medical manager and the
hospital administrator or chief executive. Exclusion criteria
included all management personnel.
Questions from the Multifactor Leadership Questionnaire (MLQ) were
adopted to measure the leadership styles of managers as perceived by
staff and questions from the Work Quality Index (WQI) were used to
measure staff job satisfaction. The MLQ was first developed by Bass in
1985 and was revised several times through subsequent research. The
Transformational leadership subscales in this instrument include
idealized influence, inspirational motivation, intellectual
stimulation and individual consideration whilst the Transactional
leadership subscales include contingent reward, management-by-
exception (both passive and active) and laissez-faire.
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The WQI was developed to measure hospital staff satisfaction with
their work quality and work environment (Whitley & Putzier, 1994) and
contains six subscales that measures job satisfaction in terms of work
worth, professional work, environment, autonomy, professional
relationships, role enactment and benefits. Permission to use these
instruments was implied because they are in the public domain (Bass &
Avolio, 2000). The formats of the instruments were modified to allow
for easier reading by the respondents. The questions remained
unchanged.
Data analysis was done using the Statistical Package for Social
Science (SPSS) Version 17. The data from the survey were analyzed to
produce descriptive statistics such as means and frequency
distributions, and inferential statistics such as Principal
Components, Pearson product-moment correlation coefficient (Pearson’s
r), and Cronbach’s alpha coefficient. The descriptive statistics
summarized demographic data and inferential statistics were used to
test the hypotheses.
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Hypothesis 1 was investigated using the descriptive statistics
procedure to find out the mean average job satisfaction score and
percentages of the various categories of respondent job satisfaction.
Hypothesis 2 was tested using Principal Component Analysis to
determine if transactional and transformational leadership styles
could be extracted as components from the data, which would then
indicate which of them is being practised by managers of the
hospitals. For hypotheses 3 and 4, Pearson’s r was used for the
relationships between leadership styles and job satisfaction. The
dependent variable was registered staff job satisfaction and the
independent variables were the transformational and transactional
leadership styles of hospital managers as perceived by staff working
in the hospital.
1.6 Scope and Limitations of the Study
The scope of this study covers the association between leadership
style and job satisfaction in private hospitals in the Sunyani
Municipality. Public hospitals were not included. It did not also
investigate causality between leadership style and job satisfaction.
The main limitation of this study, which could have implications on
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the generalizability of the results beyond this group of hospitals,
has to do with the study setting. All the respondents worked in
private-sector hospitals in only the Sunyani Municipality which is
just one municipality out of several in one region out of ten in the
country. Due to this very narrow setting, results can therefore not
be generalized to all private hospitals in the country.
1.7 Significance of the Problem
Knowing that there is a problem is about fifty percent of the
solution. Research is the best way to find which leadership styles
create job satisfaction for employees. In the Ghanaian healthcare
sector, working with less is not an expectation but a reality. For
hospital workers, job satisfaction and positive relationships with
managers and administrators is imperative in order to meet the
demanding, multi-dimensional job requirements found in hospitals. The
relationship between leadership style and job satisfaction has been
widely studied in other sectors and areas. However, there has been no
such study performed in private hospitals in the Sunyani Municipality.
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Information from this study provides pointers to resolving the problem
of how to enhance the job satisfaction of hospital workers nationwide
through leadership. For administrators, the results of this study
have numerous practical implications. Administrators can use
information from the study to educate other managers on effective
leadership styles and how these styles affect the job satisfaction of
staff.
By implementing preferred leadership styles, staff job satisfaction
will increase, creating lower turnover rates in hospitals and an
overall decrease in cedis spent for hiring and orienting new
employees. Staff satisfaction will benefit the patient in the form of
increased patient care quality. This, in turn, will create increased
patient satisfaction which will build a positive image for the
hospital in the community. The hospital will also benefit from the
workers job satisfaction which will lead to an increase in
productivity, efficiency and profit.
1.8 Organization of the Study
The study has been organized into five chapters as follows:
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Chapter One – Introduction, Background, Statement of the Problem,
Research Objectives, Questions and Hypotheses, Overview of
Methodology, Scope and Limitations, Significance and Organization of
the Study
Chapter Two – Literature Review
Chapter Three – Research Methodology
Chapter Four – Analysis and Findings
Chapter Five – Summary, Conclusions and Recommendations
CHAPTER TWO
LITERATURE REVIEW
This chapter provides a description of the theoretical framework used
to guide this study followed by research literature that supports the
purpose of this study. The chapter examined the works of some authors
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that have relevance to the topic under study and looked at leadership
styles that enhance the job satisfaction of employees within the
hospital setting. The review was structured under the following
thematic areas:
Leadership Defined; Leadership and Power; Leadership in
Healthcare Organizations
Leadership Theories:
Job Satisfaction Defined; Intrinsic and Extrinsic Job
Satisfaction; Studies on Leadership Style and Job Satisfaction
in the Hospital Setting
2.0 Theoretical Framework
2.1 Leadership Defined
The website http://www.lonnieheath.com/articles/definitions.html
quoted the following common definitions of leadership:
“The only definition of a leader is someone who has followers” by
Drucker
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“My definition of a leader … is a man who can persuade people to do
what they don’t want to do, or do what they’re too lazy to do, and
like it” by Truman
“The superior leader gets things done with very little motion. He
imparts instruction not through many words but through a few deeds. He
keeps informed about everything but interferes hardly at all. He is a
catalyst, and though things would not get done well if he weren't
there, when they succeed he takes no credit. And because he takes no
credit, credit never leaves him” by Lao Tse, Tao Te Ching
“Leadership is the ability of a superior to influence the behaviour of
a subordinate or group and persuade them to follow a particular course
of action” by Bernard
“Leadership is the ability to influence a group towards the
achievement of goals” Robbins
“Management is about coping with complexity; leadership is about
coping with change” by Kotter
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“Leadership is organizing, inspiring, and driving a group to achieve
results beyond their expectations” by Dell
“Leadership is taking a group of people in a new direction or to
higher levels of performance than they would have achieved without
you” by Fisher
These definitions by the practitioners, retrieved from the website
July 2, 2012, all point to the fact that the concept of leadership has
been severally defined. In academia, the definition of the concept
has travelled from being viewed as the art of inducing compliance, the
exercise of influence, an act or behaviour to the latter-day viewpoint
of leadership as a dynamic process (Wren, 1994). It is a process of
social influence in which one person enlists the aid and support of
others by organizing them to accomplish a common task or goal
(Chemers, 1997). Kreitner (1995) views leadership as a process of
social influence involving the voluntary pursuit of collective
objectives. For Kreitner, it is a process in which the leader seeks
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the voluntary participation of subordinates in an effort to reach
organizational goals.
An individual’s personal qualities in addition to demands of the
situation, or a combination of these and other factors attract
followers who accept the individual as a leader (Dasborough, 2006).
This implies that leadership can also be defined as one's ability to
get others to willingly follow. A leader can therefore be defined as
a person who influences a group of people towards a specific result.
Influence is the person’s ability to gain co-operation from the group
through persuasion or power over rewards. In other words, the leader
usually wields personal influence and power.
2.2 Leadership and Power
Power is a stronger form of influence because it reflects the person's
ability to enforce action through punishment. In order to remain a
leader, it is important for the leader to understand the uses of power
(Bono & Illies, 2006).
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Montana and Charnov (2008, p. 253) identify six types of
organizational power that enable the leader to influence subordinates
and peers by controlling organizational resources. Legitimate power
is described as that referring to the authority vested in hierarchical
executive positions within the organization such as Administrator,
Manager, Chief Executive Officer, etc. Such power can be inherited as
the positions become vacant from time to time. Reward power is the
power over rewards such as salary increases, promotions, allowances,
etc). Coercive Power is the authority to punish an employee through
suspension, demotion, termination, etc. Referent Power is a power
that is gained by association to the leader’s position. A person who
has power by association is often referred to as an assistant or
deputy.
Unlike the preceding types, expert power, charisma power, referent
power and information power are not given but attained personally by
the leader. The leader attains expert power from personal talents such
as skills, knowledge, abilities, or previous experience. A leader has
charisma power from inborn traits and gains information power by
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possessing important information at a time when such information is
crucial to organizational functioning.
The effective use of power is what makes an effective and successful
leader. Though only the authority of position gives the use of power
its formal backing, leadership is not dependent on title or formal
authority alone. For instance, by virtue of the authority vested in
the position, a manager has the right to command and enforce
obedience. However, in the absence of sufficient personal attributes
or competence to match this authority the manager may be confronted by
an employee or employees who may challenge his or her role in the
organization and reduce the authority to that of a figurehead.
Just like any leader, the manager must therefore wield personal
influence and power. Those appointed to formal positions in the
organizational hierarchy with commensurate authority must therefore
understand that their appointments are a legitimization of the
personal influence and power that they are assumed to wield. They
should therefore nurture, if they do not possess them innately,
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personal attributes or competence commensurate with the authority of
their positions (Bono & Illies, 2006).
2.3 Leadership in Healthcare Organizations
In most organizations, there are two groups of leadership – the
governing body and management comprising the chief executive officer
and senior managers. Healthcare organizations however have a slightly
different leadership structure. In healthcare, decisions about
diagnosis and treatment are made by the doctors and other licensed
practitioners commonly referred to as “medical staff” that provide
patient care. These decisions drive much of the organization’s use of
resources and affect the organization’s ability to achieve its goal of
providing high-quality, safe care.
Members of the medical staff, particularly doctors and other
clinicians, have been legally recognized by the state to diagnose and
treat patients. Any person without such legal recognition who
diagnoses and treats a patient through activities that are covered by
this legal recognition is deemed to be practicing illegally. It is
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therefore illegal for a non-medical staff to clinically supervise the
medical staff. The medical staff may however be administratively
supervised by a non-medical staff. It is clinical supervision that can
only be provided by someone who is also licensed to practice.
As a result, most healthcare organizations, especially hospitals, have
a third leadership group in addition to the governing body and
management. This group comprises the leaders who clinically supervise
the medical staff.
In some health care organizations, the individuals who comprise these
leadership groups may overlap. In small organizations, they may be the
same individuals, or even one individual in the smallest organization.
But the leadership function is the same, whether performed
collaboratively by different or overlapping groups, or by the same
group of individuals, or even by one person. The day-to-day running of
the healthcare organization is often the responsibility of the
hospital administrator who plans and supervises the delivery of
services by doctors, nurses, technicians and non-medical staff.
Alternative titles for the administrator’s role include Director,
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Executive Director, Chief Operating Officer, and Chief Executive
Officer.
2.4 Leadership Theories
Leadership theories were the fundamental groundwork of this study.
The theories reviewed in this section include Scientific Management,
Trait Theory, Behaviour al Theories, Situational and Contingency
Theories and the Transformational Leadership Theory.
2.5 The Scientific Management Theory
Most leadership theories invariably show influence from or trace their
roots as far back as Frederick Taylor’s scientific management theory
(Wren, 1994). Over the years the philosophical terminology of
"management" and "leadership" have, in the organizational context,
been used as synonyms. The core ideas of scientific management were
developed by Taylor in the 1880s and 1890s, and were first published
in his monographs of 1895, 1903 and 1911 (Kanigel, 1997). Scientific
management called for optimizing the way that tasks were performed and
simplifying jobs enough so that workers could be trained to perform
their specialized sequence of motions in the one best way. Taylor
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observed that some workers were more talented than others, and that
even smart ones were often unmotivated. He observed that most workers
who are forced to perform repetitive tasks tend to work at the slowest
rate without being punished. This slow rate of work has been called by
various terms in many different industries in many countries including
"hanging it out", "getting through the day", "loafing", "malingering"
and so on (Wren, 1994). Taylor used the term "soldiering" and observed
that, when paid the same amount, workers will tend to do the amount of
work that the slowest among them does (Wren, 1994).
This reflects the idea that workers have a vested interest in their
own well-being, and do not benefit from working above the defined rate
of work when it will not increase their remuneration. He therefore
proposed that the work practice that had been developed in most work
environments was crafted, intentionally or unintentionally, to be very
inefficient in its execution. He posited that time and motion studies
combined with rational analysis and synthesis could uncover one best
method for performing any particular task, and that prevailing methods
were seldom equal to these best methods. After years of various
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experiments to determine optimal work methods, Taylor proposed the
following four principles of scientific management:
1. Replace rule-of-thumb work methods with methods based on a
scientific study of the tasks
2. Scientifically select, train, and develop each worker rather than
passively leaving them to train themselves
3. Cooperate with the workers to ensure that the scientifically
developed methods are being followed
4. Divide work nearly equally between managers and workers, so that
the managers apply scientific management principles to planning
the work and the workers actually perform the tasks
Crucially, Taylor himself prominently acknowledged that if each
employee's compensation was linked to their output, their productivity
would go up (Mitcham, 2005). Thus his compensation plans usually
included piece rates. These principles were implemented in many
factories and often increased productivity. Henry Ford applied
Taylor’s principles in his automobile factories and many families in
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America and Europe even began to perform their household tasks based
on the results of time and motion studies as introduced by Taylor.
While the terms "scientific management" and "Taylorism" are often
treated as synonymous (Mitcham, 2005), an alternative view considers
Taylorism as the first form of scientific management, which was
followed by new iterations; thus in today's management theory,
Taylorism is sometimes called (or considered a subset of) the
classical perspective (meaning a perspective that's still respected
for its seminal influence although it is no longer state-of-the-art).
Taylor's own early names for his approach included "shop management"
and "process management". When Louis Brandeis popularized the term
"scientific management" in 1910, Taylor recognized it as another good
name for the concept, and he used it himself in his 1911 monograph
(Gershon, 2001).
While scientific management principles improved productivity and had a
substantial impact on industry, they also increased the monotony of
work. The core job dimensions of skill variety, task identity, task
significance, autonomy, and feedback were all missing from the picture
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of scientific management. While in many cases the new ways of working
were accepted by the workers, in some cases they were not. The use of
stopwatches was often a protested issue and led to a strike in one
factory where scientific management was being tested. Complaints that
scientific management was dehumanizing led to an investigation and a
ban by the United States Congress.
Despite its controversy, scientific management changed the way that
work was done, and forms of it continue to be used today. In the
health setting for instance, Taylor’s principles are invariably
applied especially in operating theatres and medical wards.
2.6 The Trait Theory of Leadership
Several other theories of leadership have since been developed
involving leader traits and behaviour s among others (Chemers, 1997).
The assumption that leadership is innate (i.e. rooted in an
individual’s characteristics at birth) is known as the trait theory of
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leadership (Kenny & Zaccaro, 1983). Kenny and Zaccaro (1983) revealed
that individuals can and do emerge as leaders across a variety of
situations and tasks. Other researchers also found that significant
relationships exist between leadership and individual traits. Lord,
De Vader and Alliger (1986) found leadership to be significantly
related to intelligence, adjustment and extraversion whilst Judge,
Bono, Ilies and Gerhardt (2002) found a significant relationship to
conscientiousness and openness to experience. Smith and Foti (1998)
also found a significant relationship between leadership and the trait
of self-efficacy.
While the trait theory certainly gained popularity, it is important to
note that leadership could also develop through hard work and careful
observation. As Bens (2006) observed, effective leadership can be a
product of both innate talents (i.e. nature) as well as acquired
skills (i.e. nurture). In fact, Zaccaro (2007) pointed out other
shortcomings of the trait theory such as the fact that:
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They focus on a small set of individual personality traits and
invariably neglect cognitive abilities, motives, values,
expertise, social and problem-solving skills.
They fail to take combinations of multiple attributes into
account.
They do not differentiate between those leader attributes that
are generally rigid and not pliable over time and those that are
shaped by, and bound to, situational influences.
They do not recognize the condition whereby stable leader
attributes account for the behaviour al diversity necessary for
effective leadership.
2.7 Behaviour al Theories of Leadership
In reaction to criticisms of the trait theory, researchers shifted
attention to leadership as a set of behaviour s, evaluating the
behaviour of successful leaders, determining taxonomy for leadership
behaviour, and identifying broad leadership styles (Spillane, 2004).
Several theories were developed based on behaviour al theory.
Leadership theory became known as leadership style which refers to a
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leader’s behaviour. Leadership style is the product of the leader’s
philosophy, personality and experience.
As early as 1939, Kurt Lewin, Ronald Lipitt, and Ralph White developed
their seminal work on the influence of leadership styles and
performance. The researchers evaluated the performance of groups of
eleven-year-old boys under different types of work climate. In each,
the leader exerted his influence on group decision-making, praise,
criticism (feedback) and the management of the group tasks (project
management). He exercised this influence in accordance with three
types of leadership behaviour s which they dubbed authoritarian,
democratic and laissez-faire ((Burns, 1978).
Leadership behaviour s under the authoritarian style entailed the
leader retaining all decision-making powers and not entertaining any
suggestions or initiatives from the subordinates. Only the leader
decided for the whole group and kept each decision until feeling that
it needed to be shared with the rest of the group (Burns, 1978). The
democratic leadership style consisted of the leader sharing decision-
making abilities with group members by promoting their interests and
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by practicing social equality. The laissez-faire style entailed being
in the leadership position without providing leadership, leaving the
group to fend for itself. Subordinates were given a free hand in
deciding their own policies and methods.
2.8 Situational and Contingency Theories of Leadership
Under these models, theorists began by positing that an individual’s
behaviour and actions as a leader depends in part largely upon
characteristics of the situation (Hemphill, 1949). Referred to as the
situational theory, this model assumes that different situations call
for different characteristics and therefore no single optimal
psychographic profile of a leader exists. The situational leadership
model proposed by Hersey and Blanchard (2008) suggests four
leadership-styles and four levels of follower-development. For
effectiveness, the model posits that the leadership style must match
the appropriate level of follower-development. In this model,
leadership behaviour becomes a function not only of the
characteristics of the leader, but of the characteristics of followers
as well (Hersey, Blanchard & Johnson, 2008).
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Some theorists went further by synthesizing the trait and situational
approaches. Building upon the research of Lewin and his colleagues,
they identified situations in which each of the three styles of
leadership – authoritarian, democratic and laissez-faire – works
better. The authoritarian leadership style, for example, is said to
work better under situations of crisis but fails to win the "hearts
and minds" of followers in day-to-day management; the democratic
leadership style is more adequate in situations that require consensus
building; finally, the laissez-faire leadership style is appreciated
for the degree of freedom it provides, but as the leaders do not "take
charge", they can be perceived as a failure in protracted or thorny
organizational problems (Wormer, Katherine, Besthorn, Fred & Keefe,
2007, pp:198).
Theories that emerged from the definition of leadership as contingent
upon the situation are sometimes classified as contingency theories.
Four of these theories have gained prominence in recent years: the
Fiedler contingency model, Vroom-Yetton decision model and the path-
goal theory.
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In the Fiedler contingency model, the leader's effectiveness is based
on what Fred Fiedler called situational contingency which comes about
through the interaction of leadership style and situational
favorability (later called situational control). The existence of a
good leader-follower relationship, a highly structured task, and high
leader position power is considered a "favorable situation". The
theory defined two types of leaders: those who tend to accomplish the
task by developing good relationships with the group (relationship-
oriented), and those whose primary concern is carrying out the task
itself (task-oriented) (Fiedler, 1967). According to Fiedler, the
effectiveness of the leader depends on whether his/her leadership
orientation (relationship or task) fits the situation. Fiedler found
that task-oriented leaders can more effective in extremely favorable
or unfavorable situations, whereas relationship-oriented leaders
perform best in situations with intermediate favorability.
Victor Vroom, in collaboration with Phillip Yetton (Vroom & Yetton,
1973) and later with Arthur Jago (Vroom & Jago, 1988) developed a
taxonomy for describing leadership situations in which they connected
leadership styles to situational variables and defined which style was
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more suited to which situation (Vroom & Sternberg, 2002). The novelty
in their approach lies in enabling the manager to rely on different
group decision-making approaches using the specific attributes of each
situation. Their model was later referred to as the situational
contingency theory (Lorsch, 1974).
The path-goal theory of leadership was developed by Robert House.
According to House, the essence of the theory is "that leaders, to be
effective, engage in behaviour s that complement subordinates'
environments and abilities in a manner that compensates for
deficiencies and is instrumental to subordinate satisfaction and
individual and work unit performance" (House, 1996). The theory
identifies four leader behaviour s that are contingent to
environmental factors and follower characteristics – achievement-
oriented, directive, participative and supportive. Contrary to
Fiedler, the path-goal theory states that leaders can adopt any of the
four leader behaviour s depending on what the situation demands
(House, 1996). The path-goal model can be classified both as a
contingency theory, when it depends on the circumstances, and as a
34
transactional leadership theory, when the emphasis is on the
reciprocity of behaviour between leader and the followers.
2.9 Transformational Leadership Theory
Studies on leadership began around the twentieth century. Early
theorists focused on the developing theories and hardly viewed
leadership in terms of relationships and influence. They described
leadership in terms of either the individual or the environment and
made no connection between the two. Later however, behaviour al
scientists explored the sources of power, abilities, traits and
situations that determined leadership and how groups were influenced
to accomplish goals and objectives (Marriner-Tomey, 1993).
Organizational studies and the development of better leadership models
took many different forms through the 1900s. The 1980s and 1990s
produced leadership gurus like McGregor, Peters, Waterman, Drucker,
Blanchard, and Hersey. Although each of these leadership gurus
developed his own management and leadership model, the models can be
classified under the two main categories of transactional and
transformational leadership.
35
The transactional leadership model involves the idea of giving the
worker specific tasks, with methods to accomplish them. It is a
process that “pursues a cost-benefit, economic exchange to meet
subordinates’ current material and psychic needs in return for
contracted services” (Bass, 1985, p. 14). The transactional leader
gets the job completed or the goal achieved, and the followers get
promotions, money, or other benefits. The focus of this leadership
style is task completion with the leaders often tagged as being
manipulative, detached, or inscrutable. The only possible “connection”
between leaders and followers is usually something other than a shared
vision or common purpose (Grossman & Valiga, 2000). The main
attributes of transactional leadership include contingent reward,
management-by-exception (both active and passive), and laissez-faire.
Towards the other end of the continuum is transformational leadership
which involves the idea of empowering workers and including them in
decision-making. This leadership style entails a transformational
process the leader creates by motivating, inspiring and making
followers willing to achieve organizational goals and objectives. The
36
goals and values of followers are shaped and altered, as well, so that
a collective purpose that benefits societies, organizations, or groups
can be achieved. Transformational leaders are often proactive and
innovative and they impart these characteristics into their followers
during the transformation process.
With transformational leadership, “leaders and followers raise one
another to higher levels of motivation and morality” (Burns, 1978, p.
20) which energizes them to perform beyond expectations by creating a
sense of ownership in reaching a vision (Grossman & Valiga, 2000). The
main attributes of transformational leadership include idealized
influence, inspirational motivation, intellectual stimulation, and
individual consideration.
Leadership models from the past to modern times contain aspects that
make it possible to classify them under these two main models.
Scientific management theory for instance, requires identification of
each task to be performed, the best and most cost- effective way to
perform that task, and a specific person to perform it. This task
driven idea makes it possible to classify under transactional
37
leadership model. Douglas McGregor’s Theory X leader is seen today
within the transactional leadership model while his Theory Y leader is
seen within the transformational leadership model. Peters and
Waterman’s leadership models and Peter Drucker’s leadership and
organizational structure models, which include more empowerment for
the worker, can be classified under transformational leadership. The
situational leadership model of Blanchard and Hersey which encompasses
several styles of the past and the present can equally be easily
classified under transformational leadership (Wren, 1994).
The conceptual framework of classifying leadership models as either a
transactional or transformational style is what guided this study.
This framework derives from the Transformational Leadership Theory as
first developed by Burns in 1978 and later expanded by Bass (1985)
which states that there are two different styles of leadership,
transactional and transformational.
Studies on the internal workings of organizations and development of
better leadership models continued full force through the 1990s with
an ensuing debate about whether the terms “management” and
38
“leadership” should be used as synonyms or with clearly differentiated
meanings. This debate generally reflects an awareness of a
distinction made by Burns (1978) between "transactional" leadership
(characterized by emphasis on procedures, contingent reward, and
management-by-exception for example) and "transformational" leadership
(characterized by charisma, personal relationships and creativity for
instance). Burns believed that transactional leadership is more of a
management nature.
The theoretical framework used to guide this study was the
Transformational Leadership Theory first developed by Burns in 1978
and later expanded by Bass (1985). This theory proposes that there are
only two styles of leadership, transactional and transformational and
that these two styles are stages of a leadership developmental process
(Kuhnert & Lewis, 1987).
Transactional Leadership
Transactional leadership describes the set of behaviour s that pursue
“a cost-benefit, economic exchange to meet subordinates’ current
material and psychic needs in return for contracted services” (Bass,
39
1958, p. 14). Transactional leadership is concerned with processes
rather than forward-thinking ideas. This set of behaviour s is merely
concerned with keeping things the same and hardly look to changing
things for the future. The transactional style of leadership pays
attention to the follower’s work in order to find faults and
deviations. Task completion is the focus of this type of leadership
style. Leaders with this style are often described as manipulative,
detached, or inscrutable.
With this style there may be a “connection” between leaders and
followers but it is usually something other than a shared vision or
common purpose (Grossman & Valiga, 2000). The leader enforces the
compliance of his followers through both rewards and punishments.
Transactional leaders exchange rewards for good work or positive
outcomes and punish poor work or negative outcomes until the problem
is corrected (Bass, 2008. pp. 50 & 623). The transactional leader
gets the job completed or the goal achieved through the followers, and
the followers get promotions, money, or other benefits in return for
willingly completing the job.
40
Transactional leadership thus focuses on what is referred to as
contingent reward (also known as contingent positive reinforcement)
and contingent penalization (also known as contingent negative
reinforcement). Contingent rewards (such as praise) are given when the
set goals are accomplished on-time, ahead of time, or to keep
subordinates working at a good pace at different times through to task
completion. Contingent punishments (such as suspensions) are given
when performance declines below production standards or goals and
tasks are not met at all in terms of quality or quantity.
Often, contingent punishments are handed down on a management-by-
exception basis, in which the exception is something going wrong
(Bass, 1985). Within management-by-exception, there are active and
passive routes. Active management-by-exception means that the leader
continually looks at each subordinate's performance and makes changes
to the subordinate's work to make corrections throughout the process.
The passive management-by-exception route entails leaders waiting for
problems to come up before fixing them (Bass, 2008).
41
Within the context of Abraham Maslow’s hierarchy of needs,
transactional leadership works at satisfying the worker’s basic needs
on the lower levels of the hierarchy. With transactional leadership
focusing on lower-level needs and being more managerial in style, it
is proposed as the early stage of the leadership development process
(Burns, 1978; Bass, 1985) and the foundation for the final stage,
transformational leadership, which works at satisfying the higher-
level needs of the follower (Bass, 1985).
Transactional leaders organize their world according to their personal
goals and agenda. The transactional leader attempts to get personal
needs met without equal consideration for the needs of the followers.
As the leader develops, he or she becomes aware of the interests of
others and organizes his or her world based on mutual obligations
whereby interactions take place through “exchanging” of needs. This
ushers in the final stage of the developmental process referred to as
transformational leadership (Bass, 1985).
Transformational Leadership
42
The concept of transformational leadership was first introduced by
Burns in 1978 and called “transforming leadership”. According to
Burns, transforming leadership is a process in which "leaders and
followers help each other to advance to a higher level of morale and
motivation" (Burns, 1978). Burns highlighted the difficulty in
distinguishing between management and leadership and claimed that the
differences could be found in characteristics and behaviour s. He
evoked two concepts: "transforming leadership" and "transactional
leadership". According to Burns, the transforming approach creates
significant change in the life of people and organizations. It
redesigns perceptions and values, and changes expectations and
aspirations of employees.
Unlike in the transactional approach, it is not based on a "give and
take" relationship, but on the articulation of an energizing vision,
challenging goals and the leader's personality as well as ability to
make a change through example. Transforming leaders are idealized in
the sense that they are a moral exemplar of working towards the
benefit of the team, organization and/or community. Burns viewed
43
transforming and transactional leadership styles as mutually exclusive
styles.
Thus, in contrast with transactional leadership, transformational
leadership is a process in which “leaders and followers raise one
another to higher levels of motivation and morality” (Burns, 1978).
Transformational leadership motivates followers, boosts their morale
and increases their performance. It connects the follower’s sense of
identity to the mission and collective identity of the organization.
In the manner of role models, leaders with the set transformational
leadership behaviour s inspire and challenge followers to take on
greater ownership of their work, and, understanding the strengths and
weaknesses of followers, they align followers with tasks that optimize
their performance.
Transformational leaders organize their world based on personal values
and motivate followers by imparting these values into the followers.
Motivation energizes the followers to perform beyond expectations by
creating a sense of ownership in reaching the vision (Grossman &
Valiga, 2000). It creates a “transformational” process in which
44
followers become inspired and willing to achieve organizational goals
and objectives. The goals and values of followers are shaped and
altered so that a collective purpose that benefits the organizations
can be achieved. Proactive and innovative thinking are some of the
characteristics which transformational leaders impart to followers
during the transforming process. In addition, transformational
leadership encourages followers to come up with new and unique ways to
challenge the status quo and alter the environment to support being
successful.
Introducing the term "transformational" in place of "transforming,
Bass (1985) extended the work of Burns (1978) by explaining how the
concept could be measured, as well as how it impacts follower
motivation and performance (Bass, 1985). According to Bass,
transformational leadership is measured, first, in terms of the
leader’s influence on the followers. Where followers feel trust,
admiration, loyalty and respect for the leader and are willing to work
harder than originally expected because of the leader’s qualities,
then transformational leadership is at play.
45
These outcomes occur because the transformational leader provides
followers with an inspiring mission and vision and give them an
identity, which is more than just working for self-gain. The leader
transforms and motivates followers through his or her charisma
(idealized influence), intellectual stimulation and individual
consideration. In contrast to Burns, Bass suggested that leaders can
simultaneously display both transformational and transactional
leadership behaviour s (Bass, 1985).
Leadership models from the past to modern times contain aspects that
make it possible to classify them under these two main models.
Although each of the modern leadership gurus such as Douglas McGregor,
Thomas Peters, Robert Waterman and Peter Drucker developed his own
management and leadership model, aspects of their models can be seen
in today’s transactional and transformational models of leadership
(Bass, 2008). By virtue of its task-orientation, scientific
management, one of the earlier theories, can be classified under the
transactional leadership model of today (Chen & Silverthorne, 2005).
46
In Douglas McGregor’s Theory X, managers need to rule by fear and
consequences; negative behaviour is punished and employees are
motivated through incentives. This concept makes it possible to
classify it also under the transactional leadership style. In his
Theory Y, managers work to encourage their workers. Leaders assume
the best of their employees. They believe them to be trusting,
respectful, and self-motivated. The leaders help to supply the
followers with the tools they need to excel. This idea is also
contained in the transformational leadership model (Bass, 2008).
The idea of closeness to the customer and a bias for action make the
leadership models of Peters and Waterman ideal candidates for
classification under the transformational model of leadership. Peter
Drucker’s leadership and organizational structure models, which
include more empowerment for the worker, can also be classified under
transformational leadership. The situational leadership model of
Kenneth Blanchard and Paul Hersey which encompasses several styles of
the past and the present is equally reflected in transformational
leadership (Bass, 2008).
47
By virtue of the fact that the two leadership styles, transactional
and transformational, encompass almost all the notable theories, it is
conceptually rewarding to examine the relationship between job
satisfaction and leadership style within the framework of the
Transformational Leadership Theory developed by Burns (1978) and Bass
(1985) in which they conclude that there are effectively only two
different styles of leadership, transactional and transformational.
Ultimately, whichever leadership style is adopted must produce
organizational outcomes. Though some researchers have argued that the
actual influence of leadership style on organizational outcomes is
overrated and romanticized due to biased attributions about leaders
(Meindl & Ehrlich, 1987), it is largely recognized and accepted by the
majority of practitioners and researchers that leadership is
important, and research supports the notion that leaders do contribute
to key organizational outcomes (Bass, 1990; Hersey, Blanchard &
Johnson, 2008) especially through motivation and job satisfaction.
According to Burns’ theory the ideal leadership style should be the
one that most effectively achieves the objectives of the organization
48
while balancing the interests of its individual members (Burns, 1978).
This study used Burns’ Transformational Leadership Theory as the
conceptual framework to explore the relationship between leadership
styles of administrators and job satisfaction of staff in the hospital
setting in Ghana. The Transformational Leadership Theory was adopted
as the conceptual framework in this study because it supports the idea
that effective leadership styles promote enhanced work environments
and increased job satisfaction within hospitals.
2.10 Job Satisfaction Defined
Job satisfaction is a person's emotional response to his or her job
condition. Locke (1976) defined job satisfaction as the positive or
pleasing emotional state a person enjoys after appraising his or her
job or work experience. If employees find their jobs fulfilling and
rewarding, they tend to be more satisfied (Spector, 1985). Job
dissatisfaction or low levels of job satisfaction cause absenteeism,
tardiness, low morale, high turnover, and poor quality (Lee & Ahmad,
2009). These in turn affect the overall performance of the
organization (Pitts, 2009). Job satisfaction is therefore an
important ingredient for organizational success. According to Galup,
49
Klein and Jiang (2008), while poor job satisfaction can cripple an
organization, successful organizations normally have satisfied
employees.
2.11 Intrinsic and Extrinsic Job Satisfaction
An employee’s feelings, beliefs and behaviour are the building blocks
of his or her attitude towards his or her job (Akehurst, Comeche &
Galindo, 2009) and a complex set of variables operate to determine
this attitude. Job satisfaction is influenced by a variety of factors
such as leader-follower relationships (Richmond & McCroskey, 2000),
humor (Avtgis & Taber, 2006), leader’s communication style (Richmond,
McCroskey, Davis & Koontz, 1980), etc. Hertzberg, Mausner & Snyderman
(1959) concluded that job satisfaction is determined by factors
related to the job context or environment. When a worker is highly
motivated through the provision of needs, he or she is ready and
willing to offer his or her services no matter the environment, be it
public or private, rural or urban. The needs of the worker may depend
on the job environment, content, context, etc.
Kalleberg (1977) proposed that job satisfaction consists of two
components – intrinsic (referring to the work itself) and extrinsic
50
(referring to aspects of the job external to the work itself).
Intrinsic job satisfaction refers to how employees feel about the
nature of the job tasks themselves whereas extrinsic job satisfaction
refers how they feel about aspects of the work situation that are
external to the job tasks or work itself (Shim, Lusch, & O’Brien,
2002). Today, the worker has become very sensitive to job
satisfaction. In this study the job satisfaction of private hospital
employees in the Sunyani Municipality was examined using the Work
Quality Index of Whitley and Putzier (1994) which has captured both
intrinsic and extrinsic job satisfaction in the following dimensions:
Professional Work Environment, Autonomy, Work Worth, Professional
Relationships, Role Enactment, and Benefits
2.12 Studies on Leadership Style and Job Satisfaction in the Hospital
Setting
Leadership style plays a vital role in employee job satisfaction
(Lashbrook, 1997). Different leadership styles will engender
different working environments and directly affect the job
satisfaction of employees (Timothy & Ronald, 2004). Transactional and
transformational leadership have been widely linked to positive
individual and organizational consequences (Bass, 1990). These
51
leadership styles are found to correlate positively with employee
perceptions of job, leader and organizational satisfaction. Employees
are most satisfied when they perceive their supervisors as exhibiting
both relational and task-oriented behaviour s (Felfe & Schyns, 2006).
Bass (1985) earlier proposed that, given its ability to impart a sense
of mission and intellectual stimulation, transformational leadership
might intrinsically foster more job satisfaction. Emery and Barker
(2007) later confirmed that transformational leaders, by encouraging
and motivating their followers to take on more responsibility and
autonomy enhance employees’ sense of accomplishment and satisfaction
with their job.
The role of leadership in hospital settings as a key factor in
employee job satisfaction has been explored by several investigators.
It has been found that in the hospital setting, leadership style
significantly influences staff job satisfaction either positively or
negatively.
52
In a study to examine management style and its relationship to staff
nurse job satisfaction in a public hospital in Sweden, Severinsson and
Kamaker (1999) found that that management style was directly related
to staff nurse job satisfaction (p < .003). In 1982, the American
Nurses’ Association (ANA) also sponsored a study to find out which
hospitals were successful in retaining professional nursing staff and
being highly regarded as good places to work and as giving good
nursing care (Kramer, 1990). From that study, the ANA designated
forty-one hospitals across the United States as “magnet” hospitals.
Research by Kramer and Schmalenberg (1991) later showed that the
success of the magnet hospitals was partly due to their focus on the
use of leadership style to promote job satisfaction and retain staff.
Moss and Rowles (1997) investigated the relationship between nurse job
satisfaction and management styles of head nurses through a non-
experimental, descriptive research study. Set in three acute care
Midwestern hospitals of the USA, the study found that job satisfaction
increased as perceived head nurse management styles approached the
participative style and was the highest when management style was
perceived as participative (M = 1.97). They concluded that when
53
management style is participative, staff nurses experience greater
levels of satisfaction and that increased job satisfaction is a key
factor that improves quality outcomes, patient satisfaction, and
employee retention in hospitals.
In another study in Virginia, Morrison, Jones, and Fuller (1997)
examined the effects of leadership style and empowerment on nurse job
satisfaction. They were interested in determining how staff nurses
perceived management styles, what management styles were preferred by
the staff, and if a relationship existed between the perceived
management style of the nurse manager and job satisfaction of the
staff nurses.
The Multifactor Leadership Questionnaire (MLQ) 1995 was used to
determine leadership style as either transactional or
transformational. Preferred management styles were measured using the
Profile of Organizational Characteristics developed in 1978 by Rensis
Likert Associates. Job satisfaction was measured using the Scales for
Measurement of Work Attitudes and Aspects of Psychological Well-Being
developed in 1979.
54
Transactional and Transformational leadership styles were both found
to be positively related to job satisfaction, with correlations of
0.35 and 0.64 respectively. Furthermore, the results revealed that
transactional leadership accounted for 10 percent of the total
variance in job satisfaction and transformational leadership accounted
for 30 percent of the total variance in job satisfaction.
Empowerment, which results from transformational leadership, was shown
to be positively correlated with job satisfaction.
In their study entitled “Transformational Leadership and Job
Satisfaction” Medley and LaRochelle (1995) investigated the
relationship of head nurses’ leadership style and staff nurse job
satisfaction in four hospitals in North Central Florida using the
conceptual framework developed by Burns in 1978 and refined by Bass in
1985. Convenience sampling was used and the inclusion criteria for
subjects were assignment to a staff nurse position in a clinical unit
and working under the direction of a head nurse. Leadership styles
were measured by the MLQ and classified as either Transactional or
Transformational leadership styles. The Index of Work Satisfaction
55
(IWS) was used to measure nurse job satisfaction. Leadership
components measured were charisma, individual consideration,
intellectual stimulation, contingent reward, and management-by-
exception and job satisfaction components included professional
status, interaction, organizational policy, autonomy, pay, and task
requirements.
Principal Component Analysis performed on the scores of the MLQ
revealed that the staff perceived head nurses as either Transactional
or Transformational leaders. Job satisfaction scores of the staff
nurses were correlated with the Transactional and Transformational
factor scores to determine the strength of their relationship. Staff
nurse satisfaction correlated positively with the Transformational
leadership style (r = .40, p < .001) but not with the Transactional (r
= .047, p < .001). Significant positive correlations were found
between Transformational leadership and interaction (r = .31, p
<.001), organizational policy (r = .42, p < .001), and autonomy (r
= .48, p < .001) while the relationship with Transactional leadership
showed no statistical significance. Staff nurses reported higher
levels of job satisfaction when their leader was transformational and
56
the researchers concluded that Transformational leadership prevents
turnover and promotes retention which is economically important for
hospital organizations.
In a similar study of 102 subjects from a not-for-profit Catholic
hospital in northern California, Nakata and Saylor (1994) used the
conceptual framework of Likert’s management theory to investigate the
relationship between management styles and job satisfaction. The
investigators found that the closer the perceived leadership style was
to participative (or rather transformational), the higher the level of
job satisfaction. They concluded that in the hospital setting,
leadership style has significant effects on productivity and
efficiency, and reflects on patient outcomes. The empirical
investigations reviewed above demonstrate the effects of leadership
style on job satisfaction in healthcare settings in other countries,
especially the United States of America, by establishing a
relationship between the two.
In Ghana, Anarfi, Quartey and Agyei (2010), in a study on the key
determinants of migration among health professionals, found that 24
57
per cent of private sector health employees (nurses and doctors) were
dissatisfied with their jobs due to lack of opportunities for
upgrading their skills and 18.2 per cent were dissatisfied from lack
of opportunities to rise in rank. The researchers also revealed that
63% of workers in the health sector were unable to make ends meet from
their monthly incomes. From an interviewer-administered
questionnaire, Agyapong, Anarfi, Asiamah, Ansah, Ashon and Narh-
Dometey (2004) also found that in Ghana, health workers overwhelmingly
identified low salaries as the main source of job dissatisfaction. As
poor job satisfaction creeps into the private healthcare sector,
astute leadership is required if the tide must be stemmed.
CHAPTER THREE
METHODOLOGY
3.0 Introduction
This chapter describes the methodology used in carrying out the study.
The chapter covers the research design, population, sample and
58
sampling technique, research instrument, data collection procedure and
data analysis.
3.1 Study Area
The study was set in the Sunyani Municipality of the Brong Ahafo
Region of Ghana. The Brong Ahafo Region is one of the ten regions in
the country with a total population of 2,310,983. There are 22
districts in the region. These consist of 7 municipal and 15 ordinary
districts. Sunyani serves as the capital of Brong-Ahafo region of
Ghana. Sunyani has a population of 87,642 people (2012 census) and
with a growth rate, of 3.4% per annum. There are approximately 3
public hospitals and 9 private hospitals/clinics in the municipality
with a combined workforce of approximately 250. The study focuses on
the private hospitals.
3.2 Research Design
A non-experimental, cross-sectional survey design was used in the
study. The survey design was considered appropriate because it is the
best method to describe the opinions, personal characteristics,
perceptions, preferences and attitudes of respondents (Ramey, 2002).
59
The design permitted the collection of data using questions from the
Multifactor Leadership Questionnaire (MLQ) to measure leadership
behaviour of administrators or managers by perceived staff and the
Work Quality Index to measure staff job satisfaction.
Data collected was also suitable for performing Principal Component
Analysis to determine whether hospital staff distinguished between
leadership styles of administrators and to carry out correlation
analysis to find out if a relationship existed between the perceived
leadership styles and job satisfaction in the hospital settings. The
dependent variable was job satisfaction of staff who worked in the
private hospitals and the independent variables were the leadership
styles of administrators or managers as perceived by staff.
3.3 Population
The target population of the study comprised all non-management staff
of private hospitals/clinics in the Sunyani Municipality. There are
nine private hospitals/clinics in the municipality with an estimated
total non-management staff of two hundred workers. The table below
contains private hospitals/clinics with their corresponding
established staff in the municipality:
60
Table 3.1 Private hospitals and their non-management staff in Sunyani
NAME CLINIC / HOSPITAL NO. OF NON-MANAGEMENT STAFF
Greenhill Clinic 30
SDA Hospital 30
Owusu Memorial Hospital 35
Kenam Clinic 15
Rafchik Clinic 15
Opoku Clinic 25
Healthlane Hospital 35
Penkwasi Clinic 15
TOTAL 200
Source: Survey data, 2012
3.4 Sample and Sampling Technique
A list of the nine private hospitals/clinics was obtained from the
Sunyani Municipal Health Directorate. A simple random sample of eight
(8) hospitals/clinics was drawn by numbering the list from 1 to 9
using a table of random numbers. Convenience sampling was used to
obtain a sample of 10 employees from each selected clinic in
accordance with the following inclusion criteria: a resident of the
Sunyani Municipality, employed in a private hospital/clinic in the
Sunyani Municipality, assigned to a non-supervisory, staff position in61
the hospital/clinic and working under the direct supervision of a
manager and/or an administrator in the hospital/clinic. A final
sample of 80 subjects was selected from a total of 90 employees who
met the inclusion criteria. All administrators and the heads of the
various departments of the hospitals/clinics who totaled 14 were
excluded.
These criteria for inclusion/exclusion were used because the study’s
focus was the perceptions of the staff about the leadership style of
the administrators and managers.
3.5 Research Instrument
A questionnaire was used as the instrument for gathering data for the
study. In designing the questionnaire, much attention was given to
ensure that the objectives of the research were covered in order to
make it effective. The questionnaire was used because it enables
respondents to work at their own pace and convenience. Questions
asked were mostly close-ended with few open-ended ones. The close-
ended questions were used to make it easy and less time consuming for
respondents to answer. It was also meant to keep respondents answers
62
focused on the questions. Moreover, close-ended questions were asked
to facilitate coding, analysis and cross tabulation. Questions on
leadership style were adopted from the Multifactor Leadership
Questionnaire (MLQ) whilst those on job satisfaction were adopted from
the Work Quality Index (WQI).
The WQI was developed by Whitley and Putzier in 1994 to measure the
satisfaction of nurses with their work in terms of quality and
environment. The WQI contains six subscales that measured job
satisfaction in terms of Professional Work Environment, Autonomy, Work
Worth, Professional Relationships, Role Enactment, and Benefits.
The subjects responded to 38 job-related questions using a 7-point
Likert scale of 1 = very dissatisfied, 2 = dissatisfied, 3 = somewhat
dissatisfied, 4 = neutral, 5 = somewhat satisfied, 6 = satisfied, and
7 = very satisfied. According to Whitley and Putzier (1994), the WQI
yielded a reliability coefficient of 0.94. The format of this
instrument was modified to allow for easier reading by the respondents
but the questions remained unchanged. Permission to use the WQI was
implied because it has been put in the public domain (Ramey, 2002).
63
Questions from the Multifactor Leadership Questionnaire (MLQ) were
adopted to distinguish between transactional and transformational
leadership styles of hospital managers and administrators as perceived
by staff. The MLQ was first developed by Bass in 1985 and was revised
several times through subsequent research. It is the most frequently
used survey instrument in transformational and transactional
leadership research.
Cronbach’s alpha coefficient for the MLQ ranged from .74 to .94 (Bass
& Avolio, 2000). Confirmatory Factor Analysis (CFA) was used to test
convergent and discriminant validity for each MLQ subscale. The
Goodness Fit Index (GFI) and the Root Mean Squared Residual (RMSR)
were found to be .91 and .04, respectively, indicating that the MLQ
adequately measured the dimensions of Transactional and
Transformational leadership styles (Bass & Avolio, 2000). Subsequent
validation work by Antonakis, Avolio and Sivasubramaniam (2003), using
two very large samples (Study 1: N=3368; Study 2: N=6525), provided
strong evidence supporting the validity and reliability of the
instrument.
64
The MLQ consists of 45 questions using a Likert rating scale from 0 to
4 (0 = not at all, 1 = once in a while, 2 = sometimes, 3 = fairly
often, and 4 = frequently, if not always). The MLQ has also been made
public (Ramey, 2002). In this research, the format of this instrument
was also modified to allow for easier reading by the subjects. The
questions however remained unchanged as well.
All 45 questions of the MLQ and 38 questions of the WQI were adopted
and made parts 1 and 2 of the instrument used for the present study.
3.6 Structure of the Questionnaire
The questionnaire comprised three parts. Part 1 consisted in items on
leadership style, part 2 on job satisfaction and part 3 on demographic
information. The 5-point Likert rating scale of the MLQ of Bass and
Avolio (2000), that is, 0 = not at all, 1 = once in a while, 2 =
sometimes, 3 = fairly often, and 4 = frequently, if not always was
retained for the questions in part 1 which were 45 in number on both
transactional and transformational leadership styles.
65
Transactional leadership, measured in part 1, comprised Contingent
Reward, Management-by-Exception (both active and passive), and
Laissez-Faire. In transactional leadership, contingent punishments
are often handed down on a management-by-exception basis, in which the
exception is something going wrong (Bass, 1985, pp. 14 & 121–124.).
Within management-by-exception, there are active and passive routes.
Active management-by-exception means that the leader continually looks
at each subordinate's performance and makes changes to the
subordinate's work to make corrections throughout the process. The
passive management-by-exception route entails leaders waiting for
problems to come up before fixing them (Bass, 2008).
Transformational leadership also measured in part 1, comprised
Idealized Influence, Inspirational Motivation, Intellectual
Stimulation, and Individual Consideration.
Individualized Consideration is the degree to which the leader attends
to each follower's needs, acts as a mentor or coach to the follower
and listens to the follower's concerns and needs. The leader gives
empathy and support, keeps communication open and places challenges
66
before the followers. This also encompasses the need for respect and
celebrates the individual contribution that each follower can make to
the team. The followers have a will and aspirations for self-
development and have intrinsic motivation for their tasks.
Intellectual Stimulation is the degree to which the leader challenges
assumptions, takes risks and solicits followers' ideas. The leader
stimulates and encourages creativity in their followers. The leader
nurtures and develops followers to think independently. For such a
leader, learning is a value and unexpected situations are seen as
opportunities to learn. The followers ask questions, think deeply
about things and figure out better ways to execute their tasks.
Inspirational Motivation is the degree to which the leader articulates
a vision that is appealing and inspiring to followers. Leaders with
inspirational motivation challenge followers with high standards,
communicate optimism about future goals, and provide meaning for the
task at hand. Followers need to have a strong sense of purpose if they
are to be motivated to act. Purpose and meaning are the forces that
provide the energy that drives a group forward. The visionary aspects
67
of leadership are supported by communication skills that make the
vision understandable, precise, powerful and engaging. The followers
are willing to invest more effort in their tasks and are encouraged
and optimistic about the future just as they believe in their own
abilities.
Idealized Influence provides a model of high ethical behaviour, pride,
respect and trust from the leader.
Job satisfaction, measured in part 2, consisted of 38 questions on
Professional Work Environment, Autonomy, Work Worth, Professional
Relationships, Role Enactment, and Benefits. The 7-point Likert scale
of the WQI developed by Whitley and Putzier (1994) that is, 1 = very
dissatisfied, 2 = dissatisfied, 3 = somewhat dissatisfied, 4 =
neutral, 5 = somewhat satisfied, 6 = satisfied, and 7 = very satisfied
was retained. Part 3 contained 7 questions on demographic data such
as age, experience, number of hospital beds and any other impressions
or perceptions of the respondent.
3.7 Data Collection Procedure
68
The researcher requested a list of private hospitals/clinics from the
Municipal Health Directorate. A list of 9 private hospitals/clinics
was obtained. The researcher numbered the names of the
hospitals/clinics consecutively from 1 to 9. A table of random
numbers was used to obtain a simple, random sample of 8
hospitals/clinics which were visited. The research instrument was
pre-tested in one of the selected private hospitals, Greenhill Medical
Centre, and found to be adequate in terms of clarity and focus of
questions.
The Chief Executive Officers of the 8 selected hospitals/clinics who
happen to be the owners were earlier on contacted and an introductory
letter obtained from each. On reaching each hospital, the letter was
given to the Administrator, the purpose of the visit and research
explained and assistance was sought to meet with the subordinates.
After explaining the purpose of the meeting and asking for their co-
operation, questionnaires were personally distributed by the
researcher to all 80 selected subjects.
69
Each of them was asked to complete the questionnaire and return it
within two weeks. For the sake of anonymity, the subordinates were
asked not to give out the answered questionnaires to the head but to
be collected by the researcher himself. This enabled the subordinates
to answer the questions without reservations and the answered
questionnaires were later collected on dates agreed upon by both the
respondents and the researcher. 60 questionnaires were properly
completed and returned yielding a response rate of 75%. All
completed questionnaires returned within the specified time frame were
those included in the study. Informed consent was implied in the
completion and return of questionnaires. Confidentiality and anonymity
of the participants were maintained by using only a code number on
each questionnaire.
3.8 Analysis of Data
Data were analysed using the Statistical Package for Social Sciences
(SPSS) Version 17.0. Analysis was done to produce descriptive
statistics such as means and frequency distributions, and inferential
statistics such as principal components, Cronbach’s alpha coefficient
and Pearson’s product-moment correlation. The descriptive statistics
70
of mean, median, mode, and standard deviation were used by the
researcher to summarize demographic data reported by the subjects and
test hypothesis 1.
Hypothesis 2 was tested using Principal Component Analysis to
determine if the factors of leadership styles could be extracted from
the data, which would then indicate the leadership styles practised by
managers of the hospitals. Before performing PCA, the suitability of
the data for factor analysis was assessed. The correlation matrix was
inspected for the presence of components and the size of their
respective coefficients. The Kaiser-Meyer-Oklin value was inspected
to see if it achieved the recommended value of 0.70 (Kaiser, 1974),
and the Bartlett’s Test of Sphericity (Bartlett, 1954) was performed
to find out whether it was statistically significant to support
factorability of the correlation matrix.
The Principal Component Analysis was then performed to ascertain the
presence of eigenvalues exceeding one. The scree plot was inspected
for breaks and the components with the highest variance were retained
for further investigation. To aid in interpretation of the components,
71
Varimax rotation was performed and the final factor solution used to
test the hypothesis that hospital staff were able to distinguish
between leadership styles.
The reliability of a scale indicates how free it is from random error
(Pallant, 2001). Reliability analysis was performed on the leadership
scale to find the leadership style which the workers perceive their
managers as practicing. According to Pallant (2001), when the
Cronbach’s alpha coefficient is below the recommended 0.70 it is due
to low values in the “Corrected Item-Total Correlation”. A low value
indicates that the item is measuring something different to the scale
as a whole (p. 87). Pallant (2001) suggests removing the items with
low item-total correlations to improve the Cronbach’s alpha
coefficient. Those leadership items, the removal of which improved
the Cronbach’s alpha coefficient were adjudged less perceived by the
staff.
For hypotheses 3 and 4, correlation analysis was performed and
Pearson’s r was used for the relationships between leadership styles
and job satisfaction. The dependent variable was staff job
72
satisfaction and the independent variables were the transformational
and transactional leadership styles of hospital managers as perceived
by staff. Pearson’s r was chosen because the interval level data
obtained by the researcher was suitable for producing this statistic.
73
CHAPTER FOUR
ANALYSIS AND FINDINGS
4.0 Introduction
The purpose of this chapter was to summarize the data analysis and
present as well as discuss the findings of the study. The chapter
contains a summary of the data analysis and a presentation and
discussion of the results.
4.1 Data Analysis and Presentation of Findings
The study set out to examine the relationship between leadership
styles and job satisfaction in private hospitals of the Sunyani
Municipality in Ghana. Data analysis was performed using Statistical
74
Package for Social Sciences (SPSS) Version 17.0. Descriptive
statistics were generated from the sample (N = 60) for summarizing the
socio-demographic and work characteristics of participants in the
study.
4.2 Socio-demographic and Work Characteristics
Characteristics of the final sample for the study (N = 60) were
analyzed using the descriptive statistics procedure. Seventy-five
percent of the participants were female and twenty-five percent were
male. Their ages ranged from 21 to 65 years. Seventy-three percent of
them were concentrated within the age ranges between 25 and 45 years
whilst ten participants were younger - below 25 years old.
Table 4.1 Demographic Characteristics of Sample (N=60)
Variable: Frequency (f)Percentage (%)
Gender
Male 15 25
Female 45 75
75
Age
Less than 25 years 10 17
25-34 years 20 33
35-44 years 24 40
45-54 years 3 5
More than 54 years 3 5
Education
JHS 3 5
SHS 7 12
Diploma 9 15
Professional Certificate 23 38
Bachelor of Science 9 15
Masters 8 13
PhD 1 2
Socio-demographic characteristics of sample employees of private
hospitals in Sunyani Municipality
Source: Survey Data, 2012
The typical employee of private hospitals in the Sunyani Municipality
is thus young. Only 6 participants were 54 years and above (Table
4.1). Age could play an important role in job satisfaction. In fact,
it is possible that older employees may be more difficult to satisfy
than younger ones. Equally, older employees may be more sensitive to
76
leadership style, especially when it is transactional, than younger
ones.
Five percent of the subjects completed Junior High School (JHS), 12
percent held a diploma, 53 percent held a diploma or some professional
certificate in healthcare, 15 percent held a Bachelor’s degree, 13
percent a Master’s degree and 2 percent had Doctorate degrees (see
Table 4.1). These qualifications were in nursing and other related
healthcare areas.
As to job characteristics (Table 4.2), industry experience of
participants in healthcare as a whole ranged from five years to 45
years. Eighty-seven of the participants had between 5 and 20 years of
experience in the healthcare sector and thirteen percent had more than
20 years’ experience.
77
Table 4.2 Job-related characteristics of sample (N = 60)
Variable: Frequency (f)Percentage (%)
Years Experience
0-10 years 40 67
11-20 years 12 20
21-30 years 5 8
31-40 years 2 3
More than 40 years 1 2
Hospital Size
Less than 10 beds 15 25
10-20 beds 25 41
21-30 beds 10 17
> 30 beds 10 17
Department
Critical care 10 1778
Medical/Surgical 16 26
Emergency 12 20
Pharmaceutical 10 17
General Administration 12 20
Years in Position
0-5 years 40 67
6-10 years 9 15
11-15 years 9 15
More than 15 years 2 3
Job-related characteristics of staff of private hospitals in the
Sunyani Municipality of Ghana
Source: Survey Data, 2012
As to health facility size, sixty-six percent of the sample worked in
hospitals with a size of 20 beds or less and thirty-four percent
worked in hospitals with more than 20 beds. Six-three percent of
participants were medical staff working in the critical care,
medical/surgical and emergency departments. The remaining 37 percent
worked in the pharmaceutical and general administration departments.
Majority have been in their current position for five years whilst
thirty-three percent have been in their departments for at least six
years (Table 4.2).
79
4.3 Level of Job Satisfaction
The Cronbach’s alpha coefficient estimating the reliability of the job
satisfaction subscale of the questionnaire consisting of 38 items
was .83 for the research sample. This statistic indicates good
internal consistency in the sub-scale. The coefficients for sub-
scales of the various facets of job satisfaction are as in Table 4.3
below:
Table 4.3 Cronbach’s Alpha Coefficients for Sub-scales of Job
Satisfaction Aspects
Variable No. of itemsSub Scale
Alpha
Professional Work
Environment10 .86
Autonomy 6 .87
Work Worth 4 .79
Professional
Relationships8 .85
Role Enactment 4 .74
80
Benefits 6 .84
Source: Survey Data, 2012
Work Worth Facet of Job Satisfaction
It can be seen in Table 4.4 below that respondents were satisfied that
the work they do was of some worth to themselves (95%), their
professions and to others (Table 4.4).
Table 4.4 Percent of health employees satisfied with work worth (N=60)
Variable
Employee’s satisfaction as to whether the work associated with his/her position
allows him/her to make a contribution to:
Very
satisf
ied
Satisf
ied
Somewha
t
satisfi
ed
Neutra
l
Somewhat
dissatis
fied
Dissatis
fied
Very
dissatis
fied
The hospital 30% 70% - - - - -
His/her
profession25% 75% - - - - -
His/her own sense
of achievement10% 48% 37% 5% - - -
Employee’s satisfaction as to whether the work associated with his/her position
81
provides him/her with:
The opportunity
to be of service
to others
32% 68% - - - - -
Private hospital employees’ satisfaction with aspects of work worth
Source: Survey data, 2012
Professional Relationships Facet of Job Satisfaction
Results (Table 4.5) also show that a good majority of respondents
(92%) reported having good working relationships with their
supervisors and colleagues. The percentage satisfied with
relationships with their professional superiors in general is however
a little lower (about 90%) probably be due to differences in
individual egos.
Table 4.5 Percent of health employees satisfied with professional
relationships (N=60)
VariableEmployee’s satisfaction with the working relationships existing between him/her
and:Very Satisf Somewha Neutral Somewhat Dissatis Very
82
satisfie
d
ied t
satisfi
ed
dissatisfi
ed
fied dissatis
fied
His/her
supervisor18% 68% 6% 2% 2% 2% 2%
His/her
peers24% 62% 6% 3% 3% 2% -
His/her
professiona
l superiors
15% 65% 10% 4% 2% 2% 2%
Employee’s satisfaction as to whether he/she receives:Support
from peers
for his/her
decisions
directly
related to
his/her job
25% 65% 3% 2% 3% 2% -
Support
from
superiors
for his/her
decisions
directly
related to
his/her job
15% 85% - - - - -
Employee’s satisfaction with praise received for work well done from:His/her
peers5% 15% 55% 20% 5% - -
Superiors
in his/her
profession3% 10% 17% 50% 10% 5% 5%
83
Hospital
Administrat
ion
25% 48% 7% 10% 3% 5% 2%
Private hospital employees’ satisfaction with aspects of professional relationships
Source: Survey data, 2012
The employees were satisfied with the support they received from one
another for decisions concerning their jobs. 93% were satisfied with
the support they receive from their peers to help them make decisions
directly related to their jobs. All respondents were also satisfied
with the support they receive from their supervisors and superiors in
respect of the decisions they make on their jobs which indicates that
their managers are probably concerned about their professional well-
being at work (Table 4.5). Satisfaction is not the same with respect
to praise received for work well done. 30% of employees were
satisfied with praise received from their colleagues, 55% were
somewhat satisfied and 25% were both neutral and somewhat
dissatisfied. The percentage is even lower (13%) and more
conspicuously somewhat and absent (70%) in respect to satisfaction
with praise from professional superiors or supervisors. Satisfaction
with hospital administrators however differed markedly. Eighty
84
percent of staff reported that they were satisfied with the
recognition and praise they received from hospital administrations for
work well done.
Professional Work Environment Facet of Job Satisfaction
In respect of the work environment, 50% of the respondents were
satisfied with the availability of opportunities for using the full
range of the skills they have whilst the other 50% were neutral and
somewhat dissatisfied. Also, 55% were satisfied with the variety of
work challenges they face, the remaining 45% being either somewhat
satisfied (20%) or neutral (25%). The proportions expressing
satisfaction and dissatisfaction with lack of stimulation were about
the same. Though not many employees (30%) were satisfied with the
presence of stimulation and an intellectual environment, employees
were overwhelmingly satisfied with the level of competence (90%) and
professional mutual respect (86%) engendered by the sense of
professionalism in their working environments (Table 4.6).
85
Table 4.6 Percent of health employees satisfied with work environment
(N=60)Employee’s satisfaction as to whether the work associated with his/her position
provides him/her with:Very
satisf
ied
Satisf
ied
Somewha
t
satisfi
ed
Neutra
l
Somewhat
dissatis
fied
Dissatis
fied
Very
dissatis
fied
Opportunity
to use a full
range of
skills
5% 25% 20% 45% 5% - -
A variety of
work
challenges
10% 45% 20% 25% - - -
Provides a
stimulating,
intellectual
environment
15% 15% 25% 20% 15% 10% -
Provides time
to engage in
research if
he/she wants
- 3% 5% 25% 40% 25% 2%
Promotes a
high level of
competence at
his/her
department
25% 65% 10% - - - -
Allows
opportunity
18% 68% 14% - - - -
86
to receive
adequate
respect from
workers of
other
departmentsGives clear
direction
about
advancement
3% 9% 3% 62% 5% 15% 3%
Provides
adequate
opportunities
for
advancement
3% 5% 8% 32% 20% 18% 14%
Decides
advancements
for employees
fairly
3% 8% 6% 40% 12% 18% 13%
Opportunity
for
professional
growth
5% 13% 13% 14% 25% 27% 3%
Private hospital employees’ satisfaction with aspects of professional
work environment
Source: Survey data, 2012
What cannot be missed from the results in Table 4.6 is the conspicuous
dissatisfaction with opportunities for self-development in the working
87
environment. 67% were clearly dissatisfied with the lack of freedom
or time to engage in research and 25% were neutral. In fact less than
10% were satisfied with this aspect of the professional work
environment. Also, 55% were dissatisfied with lack of opportunities
for professional growth, 14% were neutral and 31% were satisfied.
Dissatisfaction was also pronounced with regards to promotions or
advancement. Whereas highly accessible leadership (Table 4.5) may
imply frequent communication, respondents were not satisfied with the
clarity of communication about promotion. As may observed in Table
4.6, respondents were not satisfied with the clarity of direction
about advancement (only 15% indicated satisfaction), provision of
opportunities for advancement (only 16% indicated satisfaction) and
fairness in the promotion of employees (only 17% indicated
satisfaction).
Work Autonomy Facet of Job Satisfaction
From Table 4.7 below it can be seen that majority of the employees
(75%) in private sector health facilities in the Sunyani Municipality
were satisfied with the presence in their hospitals of freedom to
decide how they do their work as professionals and enjoy the
88
responsibility that comes from it. Also, 75% of them were satisfied
with the empowerment provided them by their work environment to
satisfy patient needs.
Table 4.7 Percent of health employees satisfied with autonomy (N=60)VariableEmployee’s satisfaction as to whether the work environment at his/her hospital:
Very
satisf
ied
Satisf
ied
Somewha
t
satisfi
ed
Neutral Somewhat
dissatisfi
ed
Dissatis
fied
Very
dissatis
fied
Allows him/her
to make
autonomous
professional
decisions
15% 25% 35% 20% 5% - -
Allows him/her
to be fully
accountable
for those
decisions
15% 25% 35% 20% 5% - -
Encourages
him/her you to
15% 25% 35% 20% 5% - -
89
make
adjustments in
his/her
practice to
suit patient
needs
Employee’s satisfaction as to whether his/her hospital’s organizational structure:Allows him/her
to have a
voice in
policy making
at his/her
department
5% 45% 25% 20% 5% - -
Allows him/her
to have a
voice in
overall
hospital
policy making
3% 40% 17% 25% 10% 5% -
Facilitates
his/her job25% 68% 7% - - - -
Private hospital employees’ satisfaction with aspects of work autonomy
Source: Survey data, 2012
The proportions who were satisfied that their hospitals’ structure
supported this autonomy by providing for adequate involvement of the
staff in decision-making at both departmental and hospital levels were
higher than those who said they were not; 75% as against 25% at90
department level and 60% as against 40% at hospital level respectively
(Table 4.7). This probably accounts for their overwhelming
satisfaction that the organizational structure facilitated their jobs.
Role Enactment Facet of Job Satisfaction
With respect to the role enactment facet of job satisfaction, time
pressure was not a source of dissatisfaction among the employees of
private hospitals in the Sunyani Municipality. All respondents
indicated satisfaction with their work hours. More than ninety-six
percent of the respondents felt they were given enough time to perform
tasks related either directly or indirectly to their jobs (see Table
4.8).
91
Table 4.8 Percent of health employees satisfied with role enactment
(N=60)VariableEmployee’s satisfaction as to whether he/she receives:
Very
satisfie
d
Satisf
ied
Somewha
t
satisfi
ed
Neutral Somewhat
dissatisfi
ed
Dissatis
fied
Very
dissatis
fied
Enough time
to complete
tasks
directly
related to
his/her job
20% 70% 6% 2% 2% - -
Enough time
to complete
tasks
indirectly
18% 82% - - - - -
92
related to
job his/herSupport for
his/her
work from
workers on
other
shifts
15% 75% 4% 2% 2% 2% -
Employee’s satisfaction as to whether his/her job offers:A
satisfactor
y work hour
(8 hour, 10
hour, and
so forth)
20% 80% - - - - -
Private hospital employees’ satisfaction with aspects of role
enactment
Source: Survey data, 2012
Benefits Facet of Job Satisfaction
Table 4.9 shows that respondents were satisfied with pay and other
financial/fringe benefits. However, vacation appeared to be non-
existent for employees of the hospitals – 80% were neutral about their
satisfaction with it whilst 20% indicated some dissatisfaction.
Equally, many employees were not satisfied with the availability of
93
in-service opportunities – 40% were satisfied, 20% were neutral and
40% were dissatisfied.
Table 4.9 Percent of health employees satisfied with benefits (N=60)
Variable
Very
satisf
ied
Satisf
ied
Somewha
t
satisfi
ed
Neutra
l
Somewhat
dissatisfi
ed
Dissatis
fied
Very
dissatis
fied
Employee’s satisfaction as to whether his/her job offers:
Satisfactory
salary20% 27% 28% 13% 5% 7% -
Adequate
funding for
health care
premiums
33% 53% 10% 2% 2% - -
Adequate
additional
financial
benefits other
than salary
13% 70% 13% 2% 2% - -
Adequate
vacation- - - 80% 7% 3% 10%
94
Adequate sick
leave70% 17% 13% - - - -
Adequate in-
service
opportunities
7% 3% 30% 20% 32% 8% -
Private hospital employees’ satisfaction with aspects of benefits
Source: Survey data, 2012
Overall Job Satisfaction
Overall, 78% of respondents were satisfied with their jobs with only
9% being dissatisfied and 13% remaining indifferent (Table 4.10). Job
satisfaction is however not encouraging in respect of the professional
work environment facet. Less than 50% of employees said they were
satisfied with this facet whilst as many as 26% dissatisfied and 27%
remaining neutral. These proportions are corroborated by the finding
that total job satisfaction scores ranged from 114 to 265 (Mean = 235,
SD = 17). An individual average score of 235 translates into an item
average score of 6.18 implying that the average worker was typically
satisfied with his or her job.
Table 4.10 Percent of health employees satisfied with all facets of job satisfaction
(N=60)
95
Satisfaction
Satisfied Neutral Dissatisfied
Variable
Work worth 98% 2% -
Professional
relationships81% 12% 7%
Work environment 47% 26% 27%
Autonomy 76% 17% 7%
Role enactment 98% 1% 1%
Benefits 67% 20% 13%
Overall job satisfaction 78% 13% 9%
Private hospital employees’ overall job satisfaction
Source: Survey data, 2012
4.4 Leadership Styles of Hospital Administrators as Perceived by
Staff
Using Principal Component Analysis (PCA), the data was further
analyzed to achieve the objective of examining leadership styles of
mangers of private hospitals in the Sunyani Municipality in Ghana.
PCA was used to help answer the research question as to what styles of
leadership do the workers of private hospitals in the Sunyani
96
Municipality in Ghana perceive their management as practising. The
answer to this question served to test the hypothesis that managers of
private hospitals in the Sunyani Municipality practice the
transformational style of leadership.
Prior to performing the PCA, the suitability of the data for factor
analysis was assessed using a correlation matrix and the Kaiser-
Meyer-Oklin statistic and Bartlett’s Test of Sphericity. Inspection
of the correlation matrix revealed the presence of six components
yielding a coefficient of 0.3 or above. The Kaiser-Meyer-Oklin value
was .87, exceeding the recommended value of .70 (Kaiser, 1974), and
the Bartlett’s Test of Sphericity (Bartlett, 1954) reached statistical
significance, supporting the factorability of the correlation matrix.
Using SPSS, the items on leadership in the questionnaire were
subjected to a Principal Component Analysis which revealed the
presence of two eigenvalues exceeding one, representing 67 percent and
10 percent of the total variance respectively. An inspection of the
scree plot revealed a clear break after the first component. Using
the scree test, it was decided to retain the two high variance
components for further investigation. To aid interpretation of these
97
two components, Varimax rotation was performed. The two factor
solution explained a total variance of 77 percent; with the first
factor labeled Component 1 representing 65 percent of the total
variance and the second factor, Component 2, representing 12 percent
of the total variance (see Table 4.11). The final communality
estimates indicate to what extent the components account for variables
measured. With the final communality estimates ranging from 0.81 to
0.97, we can safely conclude that all the variables are well accounted
for by the two components.
The items that loaded on the components were examined to determine if
leadership styles were clearly identified by participants and if so,
which ones. The loaded items clearly identified component 1 as the
transformational leadership style and component 2 as the transactional
leadership style. The leadership dimensions included in the
Transformational leadership component were Idealized Influence,
Individualized Consideration, Inspirational Motivation, Intellectual
Stimulation, and Contingent Reward. The three dimensions associated
with the Transactional leadership component were Active Management-by
Exception, Passive Management-by-Exception and Laissez-Faire.
98
Table 4.11 Varimax Rotation of Two Factor Solution (N=60)
Item Component
1
Component
2
Communality
estimates
Idealized Influence
(attributed).93 .85
Individualized
Consideration.90 .81
Contingent Reward .88 .87
Inspirational Motivation .85 .86
Intellectual Stimulation .87 .81
Management-by-Exception
(passive).40 .82
Management-by-Exception
(active).91 .81
Lassaiz-Faire .41 .88
% of Variance Explained 65% 12%
Varimax Rotation of Two Factor Solution and Final Communality
Estimates for Principal Component Analysis of the Leadership Sub-scale
of the Survey Instrument
Source: Survey Data, 201299
In the rotated solution in Table 4.11 above, it can be observed that
in addition to all the transformational leadership dimensions, the
transactional leadership dimension of Contingent Reward also loaded on
component one, indicating that the participants in this study
considered Contingent Reward as a transformational leadership
characteristic. The results of this analysis show that employees of
private hospitals in the Sunyani Municipality perceive their leaders
as practicing the Transformational leadership style; thus supporting
the research hypothesis that managers or administrators of private
hospitals in the Sunyani Municipality practice the transformational
leadership style.
This finding was further supported by results from the reliability
analysis of the leadership sub-scale of study’s measurement
instrument. The reliability of a scale indicates how free it is from
random error (Pallant, 2001). The Cronbach’s alpha coefficient
estimating reliability for the leadership style subscale section of
the questionnaire was initially .57 which is quite low. This was
because of low values in the corrected item-total correlations of some
100
of the items and according to Pallant (2001), low values in the
“Corrected Item-Total Correlation” of an item indicate that the item
may be measuring something different from what the scale as a whole is
measuring (p.87). He suggests removing the items with low item-total
correlations in order to improve the Cronbach’s alpha coefficient.
The situation was therefore dealt with by inspecting, identifying and
removing those items with low corrected item-total correlations.
After removing items on Management-by-Exception (both active and
passive) and Laissez-Faire which displayed low corrected item-total
correlations, reanalysis of the Cronbach’s alpha coefficient
yielded .83 for all items, a good indication of internal consistency.
The coefficients for the various dimensions of leadership style
perceived by employees as being practised by their leaders are in
Table 4.12 below:
101
Table 4.12 Cronbach’s Alpha coefficients for sub-scales of
Administrators’ leadership style
Variable Sub Scale Alpha
Idealized Influence .84
Inspirational Motivation .88
Intellectual Stimulation .78
Individualized Consideration .79
Contingent Reward .86
Cronbach’s Alpha coefficients for sub-scales of dimensions of
leadership style practised by Hospital Administrators
Source: Survey Data, 2012
4.5 Relationship between Leadership Style and Staff Job Satisfaction
In pursuit of the study’s objective of examining the relationship
between leadership styles and staff job satisfaction, Pearson product-
moment correlation analysis was used to provide answers to the
research questions as to whether any relationship exists between the102
leadership styles and job satisfaction of the workers and as to which
dimension of the leadership practised by managers of the hospitals has
the strongest positive association with job satisfaction. Correlation
analysis is the most common method of describing a relationship
between two measures (Polit & Hunglar, 1999). It allows for the
degree and direction of the relationship to be identified. It is more
informative and efficient to express the direction and magnitude of a
linear relationship by computing a correlation coefficient (Polit &
Hunglar, 1999).
Preliminary analyses were performed to ensure no violation of the
assumptions of normality and linearity. There was a strong positive
correlation between the transformational leadership component and job
satisfaction (r = .552; n = 60; p=0.003), with high levels of
transformational leadership associated with high levels of employee
job satisfaction (Table 4.12). The correlation between the
transformational leadership style and job satisfaction was
statistically significant; thus indicating that hospital executives
with a transformational leadership style give significant job
satisfaction to staff.
103
Table 4.12 Correlation between Job Satisfaction and Leadership Style
(N = 60)
Job satisfaction
Leadership style
Transactional -.220
Transformational .552*
*. Correlation is significant at the 0.05 level (2-tailed)
Correlation between Employee Job Satisfaction and Leadership Style of
Administrators in Private Hospitals of the Sunyani Municipality.
Source: Survey data, 2012
On the other hand, a weak negative correlation was found between total
job satisfaction scores and the total scores of the transactional
leadership component (r = -.220; n = 60; p = 0.02). This relationship
was however not statistically significant (Table 4.12) though it
indicates that administrators with a transactional leadership style
may induce job dissatisfaction among staff.
104
As to the nature and magnitude of the relationships between the
various dimensions of transformational leadership and job
satisfaction, strong, positive correlations were revealed between the
total job satisfaction scores and individualized consideration (r
= .696; n = 60; p = 0.000), Contingent Reward (r = .578; n = 60; p =
0.001) and inspirational motivation (r = .505; n = 60; p = 0.004).
The correlations with intellectual stimulation and idealized influence
were moderate and positive and equally statistically significant
(Table 4.13).
Table 4.14 Correlation between Job Satisfaction and Dimensions of
Leadership (N=60)
Job satisfaction
Leadership style Dimension
Inspirational Motivation .505*
Intellectual Stimulation .497*.
Individual Consideration .616*
Idealized Influence .487*
Contingent Reward .578*
*. Correlation is significant at the 0.05 level (2-tailed)
105
Correlation between Job Satisfaction of Employees and Dimensions ofLeadership Style of Administrators in Private Hospitals of the Sunyani
Municipality Source: Survey data, 2012
These results support the hypotheses that in Sunyani, there is a
significant positive association between leadership styles of private
hospital managers and job satisfaction of the hospital workers; and
that the ‘Individualized Consideration’ dimension of Transformational
leadership has the strongest positive association with job
satisfaction in private hospitals of the Sunyani Municipality.
4.6 Discussion
Important findings have emerged from the results of this study. The
findings have been useful in helping achieve the research objectives.
They support the research hypotheses. Employees of private hospitals
in the Sunyani Municipality were generally satisfied with their jobs.
The finding that most employees were not that satisfied with
availability of sufficient opportunities for using the full range of
the skills they have might probably be due to limited resources. This
106
implies that private hospitals may still have a lot to do in improving
their equipment and work environments.
The overwhelming majorities reporting satisfactory working
relationships with supervisors and administrators imply that the
hospitals foster an atmosphere of co-operation between staff and
management. Employee satisfaction with empowerment structures
provided by the hospitals imply that employees are more active in
decision making not only in professional practice and unit management
but also patient care which is a tremendous help to providing quality
care and satisfied patients.
That respondents were satisfied with pay and other fringe benefits is
inconsistent with the general view that poor remuneration is the main
source of dissatisfaction among health workers in Ghana. However,
private sector health workers’ satisfaction with salary could be
because they have been influenced by comparisons of their incomes to
those of public sector health workers. Alternatively, the fact that
non-financial factors also play a prominent role in job satisfaction
makes it difficult to argue that craving for better salaries alone
107
should make respondents less satisfied with salaries and other
financial incentives than they indicated.
Overall, employees of the private hospitals in Sunyani were satisfied
with their job and the leadership style of their managers. They
perceived their managers as practicing the transformational leadership
style, satisfaction with which brings in its wake increased
satisfaction with their jobs.
These findings are consistent with previous research elsewhere which
has revealed that employees in hospital settings, especially nurses,
distinguish between transformational and transactional leadership
styles and prefer transformational leadership styles to transactional.
Examining the relationship between leadership styles and job
satisfaction in US hospitals, Medley and LaRochelle (1995), for
instance, found that those nurses whose leaders practised
transformational leadership reported higher levels of job
satisfaction.
108
The dimension of transformational leadership that showed the strongest
positive relationship with job satisfaction in private hospital
settings in the Sunyani Municipality is Individual Consideration.
This dimension entails leader behaviour s such as listening to the
concerns of followers, providing useful advice for development,
spending time teaching and coaching, focusing on developing strengths
of followers, treating followers as individuals, giving personal
attention to followers who seem neglected, and promoting self-
development (Bass & Avolio, 2000). Obviously, such a focus by
hospital administrators might have engendered the high levels of job
satisfaction observed among the employees.
Another point of interest is that employees considered Contingent
Reward as a transformational leadership dimension. Contingent Reward
involves leaders who give followers what they want in exchange for
their support and makes clear what followers can receive if
performance meets designated standards (Bass & Avolio, 2000). Medley
and LaRochelle (1995) also found that nurses viewed Contingent Reward
as a transformational leadership dimension. But in earlier studies
performed by Bass (1985) on industrial leaders, Contingent Reward
109
emerged as a transactional leadership dimension. Continued research is
needed in the healthcare sector regarding how workers view this
leadership dimension.
These findings should however be interpreted with the following in
hindsight:
1. The fact that self-report questionnaires, which were used in the
study, run the risk of response bias due to respondents reporting
what they think the researcher is looking for rather than what
they think of themselves. This is further exacerbated by the use
of a relatively lengthy questionnaire of 92 questions. Response
burden alone could have caused answers to vary due to time
constraints, or the unwillingness of participants to read each
question adequately before responding.
110
2. Extraneous variables, such as personal stressors, could have
caused answers given by participants to be skewed. Environment
has been found to exert a powerful influence on emotions and
behaviour (Polit & Hunglar, 1999). Due to the manner in which
the data were collected, the environmental context of the study
could not be controlled.
CHAPTER FIVE
SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS
111
5.0 Introduction
This chapter contains a summary of findings, the conclusions drawn
from the research and recommendations for future research.
5.1 Summary of Findings
The primary purpose of the study was to examine the relationship
between leadership styles of hospital managers and the job
satisfaction of staff in private hospitals in the Sunyani Municipality
of the Brong Ahafo Region of Ghana. The study’s objectives were to
examine the levels of hospital employee job satisfaction, leadership
style of hospital administrators and the relationship between it and
employee job satisfaction.
Overall, about 78% of employees were satisfied with all the job
satisfaction dimensions, i.e. work autonomy, work worth, professional
relationships, benefits and role enactment. They however expressed
serious reservations about the professional work environment
particularly in respect of lack of opportunities for advancement and
professional self-development.
112
It was also found that employees perceived their leaders as practicing
transformational leadership. In the two-factor solution produced by a
Varimax rotation, transformation leadership dimensions explained 65%
of the total variance, whilst transaction leadership explained only
13%. Employees even considered Contingent Reward, assumed in the
literature to be a transactional leadership dimension, as a
transformational leadership dimension.
Transformational leadership showed a significantly strong positive
relationship with job satisfaction (r = .552; n = 60; p=0.003) whereas
transactional leadership was negatively and weakly related to job
satisfaction, a relationship which moreover was not statistically
significant (r = -.220; n = 60; p = 0.02). The relationships between
the various dimensions of transformational leadership and job
satisfaction, strong, positive correlations were revealed between the
total job satisfaction scores and individualized consideration (r
= .696; n = 60; p = 0.000), Contingent Reward (r = .578; n = 60; p =
0.001), inspirational motivation (r = .505; n = 60; p = 0.004),
intellectual stimulation (r = .497; n = 60; p = 0.002) and idealized
113
influence (r = .487; n = 60; p = 0.005). ‘Individualized
Consideration’ thus emerged as the dimension of Transformational
leadership with the strongest positive association with job
satisfaction in private hospitals of the Sunyani Municipality.
5.2 Conclusions
The findings lead to the conclusion that majority of employees in
private hospitals in Sunyani enjoy above average job satisfaction
levels. The findings equally support the conclusion that
administrators and managers of private hospitals in the municipality
practice the transformational leadership style with its attendant
consequences of increased employee job satisfaction in the hospitals.
The results indicate that hospital staff prefers managers who are
transformational leaders. They also suggest that managers who want to
increase job satisfaction should focus on Individualized Consideration
because this is the transformational leadership dimension with the
highest positive correlation with job satisfaction and likely to
positively influence the attitude of employees towards their jobs.
114
According to McClosky & McCain (1988), hospitals benefit from high
levels of staff job satisfaction because in their study, the job
performance of nurses increased proportionally with increased job
satisfaction. The product of this is productivity and efficiency
which are high priorities for hospitals in their bid to maximize
resources. Another implication of the strong link between
transformational leadership and job satisfaction is that this
leadership style, in increasing staff job satisfaction, presumably
will increase patient care quality. Increased patient care quality
will in turn reflect a positive image for the hospital in the
community which will culminate in an improved bottom line.
Assuming that job satisfaction promotes employee retention and
decreases turnover, the finding that the transformational leadership
style promotes job satisfaction has a noteworthy implication in the
face of the healthcare personnel shortage in Ghana. It assumes
crucial workplace and economic importance for hospitals. As staff
turnover decreases, hospitals can decrease overall spending for hiring
and orienting new staff, thus devoting financial and other resources
to the improvement of existing staff, patients, and hospital
115
infrastructure. In addition, the fast growing Ghanaian population
will cause an even greater demand for hospital personnel in the face
of a supply that is already limited. Hospital administrators must
find innovative ways to retain staff and enhance the workplace
environment. They can do this by increasing staff job satisfaction
through transformational leadership styles.
Employees of the hospitals want to work in an environment where they
are valued and appreciated. Instilling pride in individuals and going
beyond self-interests for the good of the group were perceived as
important characteristics of leaders which make the worker satisfied
with the job. Transformational leaders raise the others to higher
levels of motivation and morality (Burns, 1978). Motivation,
commitment and morality are particularly critical in the hospital
setting if personal errors of overuse, underuse, and misuse are to be
avoided. These however will prevail if hospital staff is incompetent
or uncommitted, or both. For instance, unless a physician is both
technically competent and committed to his or her patients, he or she
is at risk of providing the wrong care: either providing care that is
not needed, or failing to provide care that is needed, or providing
116
needed care incorrectly. Transformational leadership which engenders
job satisfaction proves to be handy in bolstering the motivation,
commitment and morality of staff. It can therefore make the hospital
a better place to work and provide superior patient care.
5.3 Recommendations
The primary recommendation of this study is that transformational
leadership programs should be drawn and implemented in hospitals, both
public and private, across the country. Within hospital
organizations, implementing transformational leadership styles require
time and energy. Managers of private hospitals in the Sunyani
Municipality appear to be emerging pioneers in transformational
leadership. Their experience and practice could be tapped and
replicated to gain on time.
Future research should focus on experimental aspects involving
implemented transformational leadership programs and their effect on
job satisfaction with particular emphasis on employee retention and
turnover rates.
117
Further research is also required on relationship between leadership
styles and patient outcomes. Many assumptions regarding the
relationship between job satisfaction, patient care quality, and
patient satisfaction have been made but these variables have not been
linked through research (Goodell & Coeling, 1994). Empirical studies
are therefore welcome to validate these assumptions or otherwise. It
would be important to correlate job satisfaction with patient care
quality and patient satisfaction. Also, a meta-analysis of variables
related to job satisfaction would afford administrators first-hand
knowledge of factors that affect the job satisfaction of staff.
Further studies must evaluate the benefits, challenges and financial
constraints of developing innovative transformational leadership
programs in meeting today’s changing health care environment.
118
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APPENDIX ‘A’
UNIVERSITY OF SCIENCE AND TECHNOLOGY
BOARD OF POSTGRADUATE STUDIES
SUBMISSION OF THESIS: POSTGRADUATE DIPLOMA
MASTER’S AND DOCTORATE DEGREES
(To be completed in Triplicate)*
A. CANDIDATE
1. Name of Candidate:
2. Department of:
3. Faculty:
4. Degree:
5. Date of Registration:
6. Approved Date of Completion:
7. Title of Thesis:
8. Date of submission to Head of Department:
9. Index No……………………….. Signature of Candidate………………………
(TEL:..................................)
B. SUPERVISOR
1. Name of Supervisor:133
2. Thesis submitted with*/without my approval:
3. Reasons (if not approved):
4. Date:…………………………… Signature……………………
(Tel:.........................
.............)
C. HEAD OF DEPARTMENT
1. Date thesis received: Signature……………………
APPENDIX ‘B’
KWAME NKRUMAH UNIVERSITY OF SCIENCE AND TECHNOLOGY
INSTITUTE OF DISTANT LEARNINGQUESTIONNAIRE
Dear Sir/Madam,
Leadership styles and job satisfaction are crucial to the development
of Ghana. Leadership styles and job satisfaction are on increasingly
competitive global economy. In order to understand the leadership
styles and its relationship to job satisfaction in the Ghanaian
134
private hospital, we provide you with the attached questionnaire. We
would appreciate it if you would kindly complete the questionnaire and
return it as soon as possible.
Thank you
NB:
Please feel free to bring any other particular problem you face in
leadership to our attention. You can use a blank paper to volunteer
additional valuable information
For purposes of anonymity and confidentiality, do not write your name
or staff identification number on any part of this questionnaire.
PART 1
135
In this part of the questionnaire, please judge how often each
statement fits your current administrator, manager or supervisor. If
you are not sure or do not know, leave the answer blank. Please use
the following rating scale:
0 = not at all; 1 = once in a while; 2 = sometimes; 3 = fairly often;
4 = frequently, if not always
Please answer the questions by circling the appropriate number.
MY ADMINISTRATOR/MANAGER OR SUPERVISOR…….
1. Provides me with assistance in exchange for my efforts 0 1 2 3 4
2. Re-examines critical assumptions to question whether they
are appropriate0 1 2 3 4
3. Fails to interfere until problems become serious 0 1 2 3 4
4. Focuses attention on irregularities, mistakes, exceptions,
and deviations from standards0 1 2 3 4
5. Avoids getting involved when important issues arise 0 1 2 3 4
6. Talks about their most important values and beliefs 0 1 2 3 4
7. Is absent when needed 0 1 2 3 4
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8. Seeks differing perspectives when solving problems 0 1 2 3 4
9. Talks optimistically about the future 0 1 2 3 4
10. Instills pride in me for being associated with him/her 0 1 2 3 4
11. Discusses in specific terms who is responsible for
achieving performance targets0 1 2 3 4
12. Waits for things to go wrong before taking action 0 1 2 3 4
13. Talks enthusiastically about what needs to be accomplished 0 1 2 3 4
14. Specifies the importance of having a strong sense of
purpose0 1 2 3 4
15. Spends time in teaching and coaching 0 1 2 3 4
16. Makes clear what one can expect to receive when
performance goals are achieved0 1 2 3 4
17. Shows that he/she is a firm believer in “If it ain’t
broke, don’t fix it”0 1 2 3 4
18. Goes beyond self-interest for the good of the group 0 1 2 3 4
19. Treats me as an individual rather than just as a member of
the group0 1 2 3 4
20. Demonstrates that problems must become chronic before
taking action0 1 2 3 4
21. Acts in a way that builds my respect 0 1 2 3 4137
22. Concentrates his/her full attention on dealing with
mistakes, complaints, failures0 1 2 3 4
23. Considers the moral and ethical consequences of decisions 0 1 2 3 4
24. Keeps track of all mistakes 0 1 2 3 4
25. Displays a sense of power and confidence 0 1 2 3 4
26. Articulates a compelling vision of the future 0 1 2 3 4
27. Directs my attention towards failures to meet standards 0 1 2 3 4
28. Avoids making decisions 0 1 2 3 4
29. Considers me as having different needs, abilities, and
aspirations from others0 1 2 3 4
30. Gets me to look at problems from many different angles 0 1 2 3 4
31. Helps me develop my strengths 0 1 2 3 4
32. Suggests new ways of looking at how to complete
assignments0 1 2 3 4
33. Delays responding to urgent questions 0 1 2 3 4
34. Emphasizes the importance of having a collective sense of
mission0 1 2 3 4
35. Expresses satisfaction when I meet expectations 0 1 2 3 4
36. Expresses confidence that goals will be achieved 0 1 2 3 4
37. Is effective in meeting my job-related needs 0 1 2 3 4
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38. Uses methods of leadership that are satisfying 0 1 2 3 4
39. Gets me to do more than I expected to do 0 1 2 3 4
40. Is effective in representing me to a higher authority 0 1 2 3 4
41. Works with me in satisfactory way 0 1 2 3 4
42. Heightens my desire to succeed 0 1 2 3 4
43. Is effective in meeting organizational requirements 0 1 2 3 4
44. Increases my willingness to try harder 0 1 2 3 4
45. Leads a group that is effective 0 1 2 3 4
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PART 2
This part of the questionnaire inquires about your level of
satisfaction with 38 job-correlated factors. Please indicate how
satisfied you are in your present job with each of these items by
circling the appropriate number.
Not
Satisfied
Satisfi
ed
1. The work associated with your position allows
you to make a contribution to:
a) Hospital 1 2 3 4 5 6 7
b) The profession 1 2 3 4 5 6 7
c) Your own sense of achievement 1 2 3 4 5 6 7
2. You receive adequate praise for work well done
from:
a) Your peers 1 2 3 4 5 6 7
b) Hospital physicians 1 2 3 4 5 6 7
c) Nursing administration 1 2 3 4 5 6 7
3. The work associated with your position provides
you with:
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a) Opportunity to use a full range of nursing
skills1 2 3 4 5 6 7
b) A variety of clinical challenges 1 2 3 4 5 6 7
c) The opportunity to be of service to others 1 2 3 4 5 6 7
4. The nursing practice environment:
a) Allows you to make autonomous nursing care
decisions1 2 3 4 5 6 7
b) Allows you to be fully accountable for those
decisions1 2 3 4 5 6 7
c) Encourages you to make adjustments in your
nursing practice to suit patient needs 1 2 3 4 5 6 7
d) Provides a stimulating, intellectual
environment1 2 3 4 5 6 7
e) Provides time to engage in research if you
want1 2 3 4 5 6 7
f) Promotes a high level of clinical competence
on your unit1 2 3 4 5 6 7
g) Allows opportunity to receive adequate
respect from nurses on other units 1 2 3 4 5 6 7
5. The hospital organizational structure:
a) Allows you to have a voice in policy making 1 2 3 4 5 6 7141
for nursing service
b) Allows you to have a voice in overall
hospital policy making1 2 3 4 5 6 7
c) Facilitates patient care 1 2 3 4 5 6 7
6. You receive:
a) Enough time to complete patient physical care
tasks1 2 3 4 5 6 7
b) Enough time to complete indirect patient care
tasks1 2 3 4 5 6 7
c) Support for your work from nurse on other
shifts1 2 3 4 5 6 7
d) Support from your peers for your nursing
decisions1 2 3 4 5 6 7
e) Support from physicians for your nursing
decisions1 2 3 4 5 6 7
7. Good working relationships exists between you
and:
a) Your supervisor 1 2 3 4 5 6 7
b) Your peers 1 2 3 4 5 6 7
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c) Physicians 1 2 3 4 5 6 7
8. Nursing service:
a) Gives clear direction about advancement 1 2 3 4 5 6 7
b) Provides adequate opportunities for
advancement1 2 3 4 5 6 7
c) Decides advancements for nurses fairly 1 2 3 4 5 6 7
9. Your job offers:
a) Opportunity for professional growth 1 2 3 4 5 6 7
b) Satisfactory salary 1 2 3 4 5 6 7
c) Adequate funding for health care premiums 1 2 3 4 5 6 7
d) Adequate additional financial benefits other
than salary1 2 3 4 5 6 7
e) A satisfactory work hour (8 hour, 10 hour,
and so forth)1 2 3 4 5 6 7
f) Adequate vacation 1 2 3 4 5 6 7
g) Adequate sick leave 1 2 3 4 5 6 7
h) Adequate in-service opportunities 1 2 3 4 5 6 7
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PART 3
DEMOGRAPHIC DATA
Please provide the following demographic information to enable us
analyze your responses in context.
Please complete:
1. Years of Age: __________
2. Level of Education: JHS SHS Diploma
Bachelors Degree Masters Degree Doctorate Degree
Other (please specify)…………………………………………………………………………
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3. How many years of experience do you as a healthcare worker?
__________
4. For how many years have you been in your current position?
__________
5. Department: Critical Care Medical/surgical
Emergency
Pharmaceutical General Administration
If your department is not mentioned above, please specify:
_____________________
6. Size of Hospital: Below 50 beds 50 to 200 beds 201
to 300 beds
301 to 400 beds Above 400 beds
7. Please make any additional comments or concerns regarding job
satisfaction or management practices at the hospital/clinic you are
currently working for which you feel would be helpful to this
study. These comments will be kept strictly confidential and are on
a voluntary basis only:
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