Running head: SERVANT AND TRANSFORMATIONAL LEADERSHIP

Servant and Transformational Leadership: Common Misconceptions in the Healthcare Field

Amanda Bryant
Siena Heights University

Servant Leadership, Employee Satisfaction, and Organizational Performance in Rural

Community Hospitals
McCann, Graves, & Cox (2014) report, that servant leadership has a positive impact on
employee and customer satisfaction. McCann et al. (2014), support this claim by asking the
following questions: to what degree are leaders in rural community hospitals servant leaders,
what the level of employee satisfaction in rural community hospitals is, and what is the
relationship between servant leadership, employee satisfaction, and the Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS) scores? McCann, et al. (2014)
imply that transformational leadership is not as effective as servant leadership. McCann, et al.
(2014) leaves open the question as to what servant leadership would be like with
transformational leadership and what it would be like if the survey area was expanded. First,
servant and transformational leadership will be defined. Next, the two will be compared. Finally,
the relationship between servant and transformational leadership, employee and job satisfaction,
and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores
will be discussed.
Transformational leadership employed with servant leadership can help an organization
reach their goals. The data collected by McCann, et al. (2014) between December 2013 and
January 2014 involved participants, limited to employees from 10 rural community hospitals located in the southeastern region of the United States. However, expanding the survey area to a
larger population will allow any flaws or inaccurate data to become visible. The degree of
servant leadership, employing some degree of transformational leadership, level of employee
satisfaction, the relationship between servant leadership, employee satisfaction, and the

(HCAHPS) scores, gives us an idea of why servant leadership is important, and why the data
collection area should be expanded.
Ultimately what is at stake here is the health and well-being of the community. McCann
et al.s (2014) theory on "Servant Leadership" is extremely useful because it sheds light on the
difficult problem of patients receiving unethical service from leadership and employees. Running
an organization, patients must come first, above how much money an organization may make, in
order for leadership to see ethics at work. As a result, everything else will fall into place. Ethics
is important when it comes to patient satisfaction. This is a part of bowing down to others.
Cloud (2006) touched on the concept of bowing down to others in his book Integrity: The
Courage to Meet the Demands of Reality. In Clouds (2006) view, to live and flourish, we must
bow to the things larger than us (p. 240). In other words Cloud (2006) believes others should be
put first in order for organizations to rise to their full potential. He utilizes two great examples
referring to his quote. The first example was a US Navy ship, the second was a company moving
to a new building for a better opportunity. In the case with the Navy ship, it wanted the
lighthouse to change its coordinates. There was some going back and forth as to who needed to
change coordinates. In the case with the company moving to a newer building with their
employees, one of the employees concerned himself with his current window office. In the
employees words, does that mean I am going to lose my window office (Cloud, 2006, p. 243)?
In both cases, neither chose to look at the bigger picture. This goes back to servant leadership.
Being a servant leader means to bow down to patients and employees. Cloud (2006) agrees
when he writes, we can push the limits all we want, thinking they will move, but ultimately we

will bow down to them (p. 240). In making this comment, Cloud (2006) urges healthcare
officials to look past current circumstances and into the future.
Evaluating the degree of servant leadership in rural community hospitals involves
utilizing descriptive statistics. The descriptive statistics included altruistic and emotional healing,
wisdom, persuasive mapping, and organizational stewardship (McCann et al., 2014). Generally
speaking, they are all needed to provide servant leadership to patients. The results displayed that
leaders performed as servant leaders 50% of the time. According to Tiaki (2014), servant
leadership is a philosophy in which the manager inspires. There are 10 principles of servant
leadership, they include: listening, empathy, healing, awareness, persuasion, conceptualization,
foresight, stewardship, commitment to the growth of people and building community (para. 1).
Taikis (2014) point is that, the principles combined with the philosophy, creates someone that is
willing to serve other over their own needs. Transformational leadership, on the other hand, is
dissimilar when utilized alone.
According to Mohammad, AL-Zeaud, & Batayneh (2011), a transformational leader is
described as a person of vision, creativity and inspiration who leads the change (p. 35).
Transformational leadership is not as effective as servant leadership, alone. Berendt, Christofi,
Kasibhatla, Malindretos, & Maruffi (2012), all argue that transformational leadership can more
broadly and deeply contribute to an organizations success over the long term (para. 1). This
leadership style has an indirect impact on patient satisfaction. It focuses on the organization, and
goals set by leadership for the organization directly. Caillier (2015) writes about the four major
components of transformational leadership, which include idealized influence, inspirational
motivation, individualized consideration, and intellectual stimulation. While utilizing these

components, leaders surely earn respect and trust from employees, establish high expectations,
provide special attention to each employee's need, and challenge the status quo. In other words,
Caillier (2015) believes these four components play a major role in leadership. Although the
dimensions including, gaining respect and trust from employees, adding meaning and challenges
to employee roles, paying attention to employee needs, and encouraging rational thought, are all
important, none of these traits of transformational leadership focus on patient satisfaction
directly. There is no direct relationship with patients. The focus of transformational leadership
includes satisfying the organization first. Patient satisfaction comes second.
When comparing the two leadership styles, transformational leadership does in fact
broaden and deepen contribution to an organizations long term success (Berendt et. al., 2012,
para. 1). However, patients are not involved in this process. The essence of Brendt et al.s (2015)
argument is that, patients and employees are cut out of the process in an effort to focus on the
goals of the organization itself. Leaders care for patients indirectly, and patient complaints and
concerns are not taken into consideration. This results in patients going to other organizations
and ultimately filing more complaints. Comparatively, patients like to see what is called salt and
light (Hayhoe, para. 1, 2013). They like to see flavor added to their service, and enjoy being
served well. Caring for patients directly allows them to know who matters most. This has been
shown in the studies on servant leadership. Servant leadership involves a different thought
process. Those unfamiliar with this school of thought may be interested to know that servant
leadership basically boils down to patient satisfaction. It involves leadership primarily taking a
patients needs and feelings into consideration first.

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

transformational leadership and job satisfaction of registered nurses in private hospitals.
Surveyors utilized The Minnesota Satisfaction Questionnaire (MSQ), and Multifactor Leadership
Questionnaire (MLQ) to measure the two factors. 200 surveys were mailed, Pearson r
correlation, and summary and descriptive statistics were used. Results show a positive
correlation between the dimensions of transformational leadership and the dimensions of job
satisfaction. In Mohammad et al.s (2011) view, the strongest relationship between internal job
satisfaction and transformational leadership has been visible among the intellectual stimulation
dimension. In other words, there is a positive correlation between job satisfaction and
transformational leadership. Healthcare officials question whether transformational leadership is
as effective as the citizens of Jordan claims it to be. According to McCann et al. (2014),
employees are in fact motivated by servant leadership to go above and beyond the basic
requirements of the job responsibilities in their interaction with customers (p. 30). What about
the level of employee satisfaction?
To determine the level of employee satisfaction in rural community hospitals, descriptive
statistics were used. This time the subscales included extrinsic, intrinsic, and general satisfaction.
McCann et al. (2014) states results that indicate general satisfaction is closer to satisfied than
dissatisfied (p. 34), meaning that external, internal, and general factors all play a role in
employee gratification. This indicates that employees enjoy having and being servant leaders.
This makes them want to do their job, and treat patients well. Transformational leadership is not
a bad thing to include in leadership. However, it should be applied with servant leadership to get
maximum results, because it does not involve patients directly. Although it is granted that

transformational leadership is not as effective as servant leadership, it is still insisted that with
the expanded survey area, there is a better view of the significance of servant leadership.
When employees are willing and able to perform their jobs, then there is a known
increased contribution. There is an increased contribution, because they are not forced to perform
their jobs. This allows employees to be servant leaders, this is what their leaders persuaded them
to do. As a result, employees with servant leaders take control of their own engagement. This has
a lot to do with personal values, goals, and visions. The scores presented comparing servant
leadership, employee satisfaction, and the (HCAHPS) scores in rural community hospitals,
indicated a positive correlation between all three. The study included subscales from both studies
above. Including extrinsic satisfaction, intrinsic satisfaction, general satisfaction, altruistic and
emotional healing, wisdom, persuasive mapping, and organizational stewardship. Pearson r
correlation and significant variables were also used.
The evidence from the Pearson r correlation, The Multivariate of Variance (MANOVA),
and descriptive statistics, performed on servant leadership in rural community hospitals, shows,
employees are more than willing to do their jobs when their leaders possess the skills of a servant
leader. Employees take control of their engagement, and are satisfied. During the two descriptive
statistics analysis, because supervisor behavior ranged from behaving as a servant leader to
behaving that way often, (McCann et al., 2014, p. 33), employee satisfaction was justified. The
behavior of supervisors is brushed onto employees. They recognize that engagement is a daily
responsibility. Furthermore, including a larger population in the survey allows the results from
both data sets to appeal to a larger crowd. This crowd not only includes patients, leaders, and

employees in rural community hospitals, but also international communities near and/or around
Jordan. It allows a visual of a much broader aspect of servant and transformational leadership.
Pearson r correlation, The Multivariate of Variance (MANOVA), and descriptive statistics
were all performed to motivate others to want to be servant leaders. The studies challenge the
work of early researchers who tend to assume that transformational leadership could be used
alone. The questions McCann et al. (2014) asks make a great point about servant leadership, and
helps answer the question of what it would be like if leadership was transformational. Servant
leaders nonetheless create a healthier working environment than transformational leaders. In
order for someone to be a servant leader, they have to have the natural feeling of wanting to
serve (Parris & Peachey, 2013). McCann et al. (2013) is warning that it cannot be forced on an
employee to do something they do not naturally want to do. Again, transformational leaders work
toward the goal of the organization while servant leaders focus solely on employee and patient
satisfaction. Data from McCann et al. (2014), and Mohammad et al.s (2011) studies suggest
that, servant leadership has a positive impact on employee and customer satisfaction in rural
community hospitals. Which in turn, has a positive impact on employee behavior. Though it is
conceded that servant leadership is necessary for patient satisfaction, it is still insisted that
including a larger population will allow a much broader view of the positive effect it has on an
organization.
After defining servant and transformational leadership, comparing them, and finally
discussing the relationship between servant and transformational leadership, employee and job
satisfaction, and the (HCAHPS) scores, the expanded population displays the significance of
servant leadership. According to Ashish (2008), this portrait of patients experience in hospitals

offers insights into areas that need improvement, and that hospitals should provide both a high
quality clinical care and a good experience for the patient (para. 4). The essence of Ashish
(2008) argument is that studies like this express the need for improvement in hospitals. Brendt et
al. (2012) writes theorists promote the idea that ineffective executives leading organizations
attempt to disguise mismanagement by unethical and even criminal acts and then exacerbate the
damage with deception (para. 2). While the findings from the study done by Caillier (2006) show
that transformational leadership has a positive effect on employee evaluations (para. 1),
servant leadership has a positive effect on the organization as a whole. Servant and
transformational leadership, employee fulfilment, the connection between servant leadership,
employee fulfillment, and the Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) scores, shows why servant leadership is important, and why the data
collection area should be expanded. It is understandable that transformational leadership is
theoretically and empirically (Mohammad et al., 2011, p. 36) proven, however, this does not
dismiss its effectiveness on patient satisfaction.

References
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