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

1

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.

2

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

3

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).

4

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

5

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

6

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?

7

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.

8

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.

9

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.

10

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

11

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.

12

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:

13

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

14

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

15

“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

16

“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

17

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).

18

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

19

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,

20

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

21

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,

22

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

23

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

24

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

25

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

26

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

27

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:

28

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

29

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

30

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).

31

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.

32

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

33

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

REFERENCE

Anarfi, J., Quartey, P. & Agyei, J. (January 2010). Key

Determinants of Migration Among Health Professionals in Ghana.

Development Research Centre on Globalization, Migration and

Poverty.

119

Agyepong I, Anarfi P, Asiamah E, Ansah E. K, Ashon D. A, Narh-

Dometey C. (2004) Health Worker (internal customer) Satisfaction

and Motivation in The Public Sector in Ghana. International

Journal of Health Planning and Management, 19, 319-336.

Akehurst, G., Comeche, J. M., & Galindo M. (2009) Job

satisfaction and commitment in the entrepreneurial SME. Small

Business Economics, 32, 277–289.

Antonakis, J., Avolio, B. J. & Sivasubramaniam, N. (2003) Context

and leadership: an Examination of The Nine Factor Full-Range

Leadership Theory Using the Multifactor Leadership Questionnaire.

The Leadership Quarterly, 14, 3, 261-295.

Avtgis, T. A. & Taber, K. R. (2006) I laughed so hard my Side

Hurts, or is that an Ulcer? The Influence of Work Humour on Job

Stress, Job Satisfaction, and Burnout among Print Media

Employees. Communication Research Reports, 23, 13-18.

Bartlett, M. (1954) A Note on the Multiplying Factors for Various

chi Square Approximations. Journal of the Royal Statistical

Society, 16, 296-298.

Bass, B. M. (1985) Leadership and Performance beyond

Expectations. New York, NY: The Free Press.

120

Bass, B.M. (1990) Transformational leadership. New York, NY:

Lawrence Erlbaum Associates.

Bass, B. M. (2008). Bass & Stogdill's Handbook of Leadership:

Theory, Research & Managerial Applications. 4th ed. New York, NY:

The Free Press.

Bass, B. M. & Avolio, B. (2000). The Multifactor Leadership

Questionnaire. 2nd ed. Redwood City, CA: Mind Garden, Inc.

Bens, Ingrid (2006) Facilitating to lead. Chicago, IL Jossey-

Bass.

Bloom, G. & Standing, H. (2001) Human Resources and Health

Personnel. Africa Policy Development Review, 1, 7-19.

Bono J.E. & Ilies R. (2006) Charisma, Positive Emotions and Mood

Contagion. The Leadership Quarterly, 17, 4, 18-21.

Burns, J. M. (1978) Leadership. New York, NY: Harper and Row

Publishers Inc.

Chemers M. (1997) An Integrative Theory of Leadership. Mahwah,

NJ, USA: Lawrence Erlbaum Associates.

121

Chen, J. & Silverthorne, C. (2005) Leadership Effectiveness,

Leadership Style and Employee Readiness. Leadership &

Organization Development Journal, 26, 4, 280-288.

Chernichovsky, D. & Bayulken, C. (1995) A Pay-for-Performance

System for Civil Service Doctors: the Indonesian experiment.

Social Science & Medicine, 41, 2, 155-161.

Dasborough, M.T. (2006) Cognitive Asymmetry in Employee Emotional

Reactions to Leadership Behaviour s. The Leadership Quarterly,

17, 2, 18-21.

Dudley, R. A. (2005) Pay for Performance Research: What

Clinicians and Policy Makers Need to know. JAMA, 294, 1821-1823.

Eichler, R. (2006) Can “Pay for Performance” Increase Utilization

by the Poor and Improve the Quality of Health Services?

Discussion Paper for the First Meeting of the Working Group on

Performance-Based Incentives. Center for Global Development.

Retrieved August 14, 2012 from

http://www.cgdev.org/section/initiatives/_active/ghprn/

workinggroups/performance.

Emery, C. R. & Barker, K. J. (2007) The Effect of Transactional

and Transformational Leadership Styles on the Organizational

Commitment and Job Satisfaction of Customer Contact Personnel.

122

Journal of Organizational Culture, Communication & Conflict, 11,

1, 77-90.

Felfe, J. & Schyns, B. (2006) Personality and the Perception of

Transformational Leadership: the Impact of Extraversion,

Neuroticism, Personal need for Structure, and Occupational Self-

Efficacy. Journal of Applied Social Psychology, 36, 708–41.

Fiedler, Fred E. (1967) A Theory of Leadership Effectiveness.

McGraw-Hill: Harper and Row Publishers Inc.

Fisher, E. (2009) Motivation and Leadership in Social Work

Management: a Review of Theories and Related Studies.

Administration in Social Work, 33, 347-367.

Galup, S. D., Klein, G. & Jiang, J. J. (2008) The Impact of Job

Characteristics on Employee Satisfaction: A Comparison Between

Permanent and Temporary Employees. Journal of Computer

Information Systems, 48, 4, 58-68.

Garrett, B. (1991) The Relationship Among Leadership Preferences,

Head Nurse Leadership Style, and Job Satisfaction of Staff

Nurses. The Journal of the New York State Nurses Association, 22,

4, 11-14.

123

Gershon, Richard (2001) Telecommunications Management: Industry

Structures and Planning Strategies. Mahwah, NJ, USA: Lawrence

Erlbaum Associates

Global Equity Initiative (2004) Human Resources for Health:

Overcoming the Crisis. Joint Learning Initiative Cambridge,

Massachusetts: Harvard University Press.

Goodell, T. & Coeling, H. (1994) Outcomes of Nurses’ Job

Satisfaction. Journal of Nursing Administration, 24, 11, 36-41.

Gray, B. (1991) Are California Nurses Happy? California Nursing,

13, 12-17.

Grossman, S. & Valiga, T. (2000) The New Leadership Challenge:

Creating the Future of Nursing. Philadelphia, PA: F. A. Davis

Company.

Hemphill, John K. (1949) Situational Factors in Leadership.

Columbus: Ohio State University Bureau of Educational Research.

Hersey, P., Blanchard, K. & Johnson, D. (2008) Management of

Organizational Behaviour : Leading Human Resources. 9th ed. Upper

Saddle River, NJ: Pearson Education.

Herzberg F., Mausner B. & Snyderman, B. (1959) The Motivation to

work. New York, NY: John Wiley & Sons Inc.

124

House, Robert J. (1996) "Path-Goal Theory of Leadership: Lessons,

Legacy, and a Reformulated Theory". Leadership Quarterly, 7, 3,

323-352.

http://www.lonnieheath.com/articles/definitions.html (2012)

Common definitions of (Retrieved 2nd July, 2012)

Judge, T.A., Bono, J.E., Ilies, R. & Gerhardt, M.W. (2002)

Personality and Leadership: A Qualitative and Quantitative

Review. Journal of Applied Psychology, 87, 765-780.

Kaiser, H. (1974) An Index of Factorial Simplicity.

Psychometrika, 39, 31-36.

Kalleberg, A.L. (1977) Work Values and Job Rewards: A Theory of

Job Satisfaction. American Sociological Review, 42, 124-143.

Kanigel, Robert (1997) The One Best Way: Frederick Winslow Taylor

and the Enigma of Efficiency. New York, NY: Penguin-Viking.

Kenny, D.A. & Zaccaro, S.J. (1983) An Estimate of Variance due to

Traits in Leadership. Journal of Applied Psychology, 68, 678-685.

Kramer, M. (1990) The Magnet hospitals: Excellence revisited.

Journal of Nursing Administration, 29, 9, 35-44.

125

Kramer, M. & Schmalenberg, C. (1991) Job Satisfaction and

Retention. Insights for the '90s. Part 1. Nursing, 21, 3, 50-55.

Kreitner, R. (1995) Management. Chicago, IL: Jossey-Bass.

Kuhnert, K. & Lewis, P. (1987) Transactional and Transformational

Leadership: A Constructive/Developmental Analysis. Academy of

Management Review, 4, 648-657.

Lashbrook, W. (1997) Business Performance, Employee Satisfaction,

and Leadership Practices. Performance Improvement, 36, 5, 29-33.

Lee, H. Y. & Ahmad, K. Z. (2009) The Moderating Effects of

Organizational Culture on the Relationships Between Leadership

Behaviour and Organizational Commitment and Between

Organizational Commitment and Job Satisfaction and Performance.

Leadership & Organization Development Journal, 30, 1, 53-86.

Lewin, K., Lippitt, R. & White, R. (1939) "Patterns of Aggressive

Behaviour in Experimentally created Social Climates". Journal of

Social Psychology, 10, 271-301.

Locke, E. A. (1976) The Nature and Causes of Job Satisfaction. In

M. D. Dunnette Handbook of Industrial and Organizational

Psychology, 1297-1349. Chicago, IL: Rand McNally.

126

Lord, R. G., De Vader, C. L. & Alliger, G. M. (1986). A Meta-

Analysis of the Relation Between Personality Traits and Leader

Perceptions: An Application of Validity Generalization

Procedures. Journal of Applied Psychology, 71, 402-410.

Lorsch, Jay W. (Spring, 1974) "Review of Leadership and Decision

Making". Sloan Management Review.

Marriner-Tomey, A. (1993) Transformational leadership in nursing.

St. Louis, MO: Mosby-Year Book.

McClosky, J. & McCain, B. (1988) Variables related to nurse

performance. Image, 20 (4), 203-207.

Manongi, R., Marchant, T. & Bygbjerg, I.C. (2006) Improving

motivation among primary care workers in Tanzania: A health

worker perspective. Human Resources for Health 2006, 4, 6.

Mathauer, I. & Imhoff, I. (2004) Staff Motivation in Central

America and Africa: The impact of non-financial Incentives and

quality management tools. Gesellschaft fur Technische

Zusammenarbeit, Eschborn

Mathauer, I. & Imhoff, I. (2006) Health worker motivation in

Africa: the role of nonfinancial incentives and human resource

management tools. Human Resources for Health 2006, 4, 24.

127

McClure, Margaret L. & Hinshaw, Ada Sue (1983) Magnet hospitals

revisited: Attraction and retention of professional nurses. New

York, NY: American Nurses Association, Inc.

Medley, F., & LaRochelle, D. (1995) Transformational leadership

and job satisfaction. Nursing Management, 26, 9, 64JJ-64LL, 64NN.

Meindl, J. R. & Ehrlich, S. B. (1987) The romance of leadership

and the evaluation of organizational performance. Academy of

Management Journal, 30, 1, 91-109.

Mitcham, Carl (2005) "Management", Encyclopedia of science,

technology, and ethics, 3, Macmillan Reference USA. Retrieved

August 17, 2012 from http://books.google.es/books?

id=eaIRAQAAMAAJ.

Montana, Patrick J. & Charnov, Bruce H. (2008) Management:

Leadership and theory. 4th English ed. New York, Haupauge:

Barron's Educational Series, Inc.

Morrison, R., Jones, L., & Fuller, B. (1997) The relationship

between leadership style and empowerment on the job. The Journal

of Nursing Administration, 27, 5, 27-34.

Moss, R. & Rowles, C. (1997) Staff nurse job satisfaction and

management styles. Nursing Management, 28, 1, 32-34.

128

Nakata, J. & Saylor, C. (1994) Management style and staff nurse

satisfaction in a changing environment. Nursing Administration

Quarterly, 18, 3, 51-57.

Pallant, J. (2001) SPSS survival manual. Philadelphia, PA: Open

University Press.

Pitts, D.W. (2009) Diversity management, job satisfaction, and

performance: evidence from US Federal Agencies. Public

Administration Review, 69, 2, 328-38.

Polit, D. & Hungler, B. (1999) Nursing research: Principles and

methods. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins.

Ramey, Jan Warner (2002) The relationship between leadership

styles of nurse managers and staff nurse job satisfaction in

hospital settings. Thesis, MSc. in Nursing. Marshall University

College of Nursing and Health Professions, Huntington, West

Virginia.

Rantz, M., Scott, J. & Porter, R. (1996) Employee motivation: new

perspectives of the age-old challenge of work motivation. Nursing

Forum, 31, 3, 29-36.

129

Richmond, V. P. & McCroskey, J. C. (2000) The impact of

supervisor and subordinate immediacy on relational and

organizational outcomes. Communication Monographs, 67, 85-95.#

Richmond,V. P., McCroskey, J. C., Davis, L. M. & Koontz, K. A.

(1980) Perceived power as a mediator of management style and

employee satisfaction: a preliminary investigation. Communication

Quarterly, 28, 37-46.

Sanders, D., Dovlo, D., Meeus, W. and Lehmann, U. (2003) ‘Public

Health in Africa.’ In Beaglehole, R. Global Public Health: a New

Era, Oxford: Oxford University Press.

Severinsson, E. & Kamaker, D. (1999) Clinical nursing supervision

in the workplace: effects on moral stress and job satisfaction.

Journal of Nursing Management, 7, 2, 81-90.

Shim, S., Lusch, R. & O'Brien, M. (2002) Personal values,

leadership styles, job satisfaction and commitment: an

exploratory study among retail managers. Journal of Marketing

Channels, 10, No. 1, 65-87.

Smith, J.A. & Foti, R.J. (1998) A pattern approach to the study

of leader emergence. The Leadership Quarterly, 9, 147-160.

130

Spector, P. E. (1985) Measurement of human service staff

satisfaction: development of the job satisfaction survey.

American Journal of Community Psychology, 13, 693-713.

Spillane, James P. (2004) "Towards a theory of leadership

practice". Journal of Curriculum Studies, 36, 1, 3-34.

Timothy, A. J. & Ronald, F. P. (2004) Transformational and

transactional leadership: a meta-analytic test of their relative

validity. Journal of Applied Psychology, 89, 5, 755-768.

Tumulty, G., Jernigan, I. E. & Kohut, G. (1995) Reconceptualizing

Organizational Commitment. Journal of Nursing Administration, 25,

61-65.

Van, Wormer, Katherine, S., Besthorn, Fred H. & Keefe, Thomas

(2007) Human behaviour and the social environment: macro level:

groups, communities, and organizations. Oxford: Oxford University

Press.

Vroom, Victor H. & Jago, Arthur G. (1988) The new leadership:

managing participation in organizations. Englewood Cliffs, NJ:

Prentice-Hall.

Vroom, Victor H. & Sternberg, Robert J. (2002) "Theoretical

letters: the person versus the situation in leadership". The

Leadership Quarterly, 13, 3, 301-323.

131

Vroom, Victor H. & Yetton, Phillip W. (1973) Leadership and

decision-making. Pittsburgh: University of Pittsburgh Press.

Whitley, M. & Putzier, D. (1994) Measuring nurses’ satisfaction

with the quality of their work and work environment. Journal of

Nursing Care Quality, 8, 3, 43-51.

World Health Organization (2006) Working together for health:

World Health Report 2006. Geneva: The World Health Organization.

Wren, D. A. (1994). The evolution of management thought (4th

ed.). Upper Saddle River, NJ: John Wiley & Sons.

Yukl, G. A. (2005) Leadership in organizations. 6th ed. Upper

Saddle River, NJ: Prentice-Hall.

Zaccaro, S. J. (2007) Trait-based perspectives of leadership.

American Psychologist, 62, 6-16.

132

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

136

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

138

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

139

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:

140

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

142

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

143

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)…………………………………………………………………………

144

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:

145

146