leadership style and its relationship to culture in an aging services provider organization a case...

7/24/2019 Leadership Style and Its Relationship to Culture in an Aging Services Provider Organization a Case Study Utilizing

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LEADERSHIP STYLE AND ITS RELATIONSHIP TO

CULTURE IN AN AGING SERVICES PROVIDER ORGANIZATION:

A CASE STUDY UTILIZING FLEXIBLE DESIGN

by

Michele D. Holleran

A Dissertation Presented in Partial Fulfillment

Of the Requirements for the Degree

Doctor of Philosophy

Capella University

December 2006


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UMI Number: 3239154

3239154

2007

Copyright 2007 by

Holleran, Michele D.

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by ProQuest Information and Learning Company.


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Michele D. Holleran, 2006


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Abstract

Leadership characteristics that foster culture change and staff retention in an organization

providing housing and services to the aging are uncovered using a microanalysis technique in

this embedded case study. Although recent research (Thyer, 2003) in healthcare environments

conclude that transformational leadership (Bass & Avolio, 1990; Burns, 1978) is the style most

conducive to achieving the two outcomes, the author of this dissertation posits that elements of

Level 5 leadership (Collins, 2001) and servant leadership (Greenleaf, 1991) are also critical.

Culture change and staff retention are imperative to the vitality and success of the aging services

field over the next 2 decades.


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iii

Dedication

I dedicate this dissertation to Robert L. Wenrich, my father, lifelong friend and mentor,

and an extraordinary educator.


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iv

Acknowledgments

I would like to acknowledge the people who have helped me in my journey to attain a

PhD. First, I thank my parents, Robert and Karol Wenrich, who always emphasized the

importance of education and giving my best to any endeavor. My parents have always been my

greatest cheerleaders, and for that I am eternally grateful to them.

Second, I express heartfelt appreciation to my husband, Brad Holleran, and our children,

Robbie and Shannon, who were patient and understanding over the past 5 years while I had my

nose in hundreds of books and articles preparing for this degree. I especially appreciate the

encouragement of my husband and the many nights he prepared dinner so I could pursue my

studies. I am grateful to my husbands parents, Bert and Barb Holleran, for their support and

inspiration throughout this process. I also would like to acknowledge the love and

encouragement of my three sisters, Melinda Scott, Kathy Stoltzfus, and Jennifer West.

My business partners, Lisa Lehman and Cindy Osborne at Holleran Consulting, are

appreciated for their unending support and carrying the load of the business affairs while I was

pursuing this degree. My appreciation is also extended to Dr. Nancy King, Dr. Kathryn Roberts,

and Janet Green, three professional colleagues who served as peer reviewers for my dissertation.

A special note of thanks goes to my mentor, Dr. Mary Evans, for the many times she

offered advice over coffee and by phone. I appreciate all the times she challenged me to think

harder and check my assumptions. To Dr. Edward Felton Jr., I owe gratitude for his guidance,

friendship, and incredible sense of humor. I also thank Dr. Shanker Menon, the third member of

my committee, for his wisdom. I am also grateful to my adviser, Dr. Mark Larson of Capella

University, who helped me negotiate through many details, especially during the final phases of

writing this dissertation.


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Recognition of all members of the organization about which this case study research is

written is appropriate, especially the CEO and the Director of Communications, who were so

very gracious with their cooperation during this process. I also wish to acknowledge the 37 other

individuals who allowed me to interview them for this study.

Finally, my thanks to Susan Werner and Kathy Flavin, who provided technical support

and friendship to me as I completed this dissertation.


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Table of Contents

Acknowledgments iv

List of Tables ix

List of Figures x

CHAPTER 1. INTRODUCTION 1

Introduction to the Problem 1

Background of the Study 4

Statement of the Problem 5

Purpose of the Study 6

Rationale 7

Research Questions 8

Significance of the Study 9

Definition of Terms 10

Assumptions and Limitations 12

Nature of the Study or Theoretical/Conceptual Framework 12

Organization of the Remainder of the Study 15

CHAPTER 2. REVIEW OF THE LITERATURE 16

Rationale for the Research 16

Theory Generating the Question and Exploring the Foundations of the Field 17

Summary 35

CHAPTER 3. METHODOLOGY 38

Purpose of the Study 38

Theoretical Framework: Initial Research Questions and Objectives 41


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Research Design 41

Rationale for Methodology 42

Sampling Design 44

Procedures for Consent to Participate, Participants at Risk and Confidentiality 46

Methods and Procedures for Data Collection, Including Researcher Participation 47

Data Analysis Procedures 49

Limitations of Methodology 50

Ethical Issues 52

CHAPTER 4. DATA COLLECTION AND ANALYSIS 54

About the Organization 56

Interviews and Focus Groups 56

How Data Were Coded 58

Open Coding of the Data 63

Leadership Characteristic 1: Transparency 68

Leadership Characteristic 2: Trustworthiness 70

Leadership Characteristic 3: Connectivity 72

Leadership Characteristic 4: Accountability 75

Leadership Characteristic 5: Empowerment 79

Leadership Characteristic 6: Optimism 80

Discovery of Six Connector Concepts 83

Conceptual Framework 85

Conclusion 93

CHAPTER 5. RESULTS, CONCLUSIONS, AND RECOMMENDATIONS 95


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Other Findings Important to Note 97

Application of the Conceptual Framework 99

Research Recommendations 101

How the Conceptual Framework Relates to Other Leadership Theories 103

Conclusion 105

REFERENCES 107

APPENDIX A INTERVIEW AND FOCUS GROUP GUIDES 116

APPENDIX B DATA COLLECTION MATRIX 120


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ix

List of Tables

Table 1. Participant Profile 55

Table 2. 2006 Nursing Home Turnover Statistics 62

Table 3. Leadership Characteristics Inspiring Culture Change 64

Table 4. Theoretical Underpinnings Associated With Identified Leadership Characteristics 65

Table 5. Disconfirming Evidence Noted Within Organizational Culture 67

Table 6. Similarities Between Constructs of Transformational Leadership 104


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x

List of Figures

Figure 1. Researchers original conceptual framework. 15

Figure 2. The dashboard. 78

Figure 3. Conceptual framework of leadership characteristics and connector conceptsleading to culture change and employee retention. 85


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CHAPTER 1. INTRODUCTION

Introduction to the Problem

The field of aging services faces challenges that threaten its future. Among these is a

labor shortage that will result in unprecedented vacancies and turnover rates among direct care

workers. Annual turnover rates today in aging services organizations range from 45% to 100%

depending upon the position to be filled. Among the most challenging is the position of certified

nursing assistant (CNA), which has a 71% annual turnover rate nationally. Significant societal

factors will result in a 21st century crisis in the long term care direct care workforce. The elderly

population requiring aging services is burgeoning (about 43% of persons turning 65 will require

skilled nursing care before they die) at a time when the care gap is increasing. Because of this

care gap, millions of elderly in the United States risk receiving insufficient or sub-standard care

from the nations network of aging services providers (U.S. Department of Health and Human

Services, 2004).

The reasons for the care gap are many, but the major causes are low pay and insufficient

benefits, inadequate job orientation and the lack of mentoring, poor leadership and supervision,

physically and emotionally exhaustive work, workplace stress and burnout and shortage in

staffing levels at individual facilities (Stone, 2001; Stone & Weiner, 2001). Generational

differences may contribute to misunderstandings among workers (Lancaster & Stillman, 2002).

Moreover, the culture of aging services is viewed as being highly-transactional (authoritative,

task-focused), which is believed to contribute to the high turnover of staff (Thyer, 2003). At the


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same time, the United States Bureau of Labor Statistics (USBLS, 2004b) forecasts the need for

more than 1.2 million new direct care workers by the year 2010.

Research conducted by the California Association of Homes and Services for the Aging

and the Institute for the Future of Aging Services (IFAS) found that a major source of job

dissatisfaction by direct care staff in long-term care settings was the feeling of not being valued

or respected by their supervisors. Bowers, Esmond, and Jacobson (2003), in their study to

determine why certified nursing assistants (CNAs) leave their jobs, discovered that high turnover

is directly connected to feelings of being unappreciated and undervalued. This connection points

to the need for empowerment of the workforce and higher trust levels between labor and

management within the aging services setting.

Parsons, Simmons, Penn, and Furlough (2003) performed a multivariate analysis of data

from a 1996 survey of nursing assistants employed in Louisiana nursing homes and confirmed

that professional growth, involvement in work-related decisions, supervision and communication

between management and employees were significantly correlated to turnover and job

satisfaction. Pennington and Magilvy (2003) came to similar conclusions in their research. Eaton

(2001) concluded that five managerial practices characterize environments with lower turnover

and better retention of direct care staff: (a) high quality leadership, (b) valuing and respect

toward direct caregivers, (c) positive human resource practices, (d) organizational environments

that are relationship-driven, and (e) sufficient staffing levels conducive to high quality care.

The connection between high turnover rates in healthcare organizations and transactional-

based cultures also is well documented. Thyer (2003) posited that the nursing shortage is being

caused by health care leadership that is transactional in nature, stating that nurses struggle

ideologically with the system in which they work. She wrote: nurses are not only disempowered


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through a transactional model; they also have minimal autonomy (p. 77). Thyer recommended

adoption of Eusons model of team communication as one way to begin empowering direct care

nursing staff such as certified nursing assistants (CNAs). The model relies heavily on listening

and questioning, providing and receiving feedback, encouraging brainstorming and consensus-

building, empowerment, and promotion of a shared vision (Euson, 1994, p. 3). Laschinger and

Finegan (2005) found a similar relationship between empowerment and the retention of nurses

and other front-line workers in hospitals and long-term care facilities. They argued that work

environments manifesting justice, trust and respect facilitate a culture of retention.

Manion (2004) conducted research among 26 nurse managers from around the country

and discovered that cultures of retention come about when supervisors put the needs of their staff

first. Specific behaviors identified included caring about workers as individuals, treating them

with respect and high regard, using appreciation and recognition liberally, listening and being

responsive and providing support as required. Arruda (2005) found that the development of

trusting relationships between supervisors and their subordinates was the key to better retention.

Thyer (2003) posited that transformational leadership (a leadership style that emphasizes

relationship-building) has a positive affect on communication, team building and trust in a

hospital setting. Thyer stated that this particular leadership style is ideologically suited to

workplaces where nurses are employed because nurses are visionary, creative and involved in

decision making at the patient level (p. 73). Certain leadership styles are more compatible with

some organization structures, according to Paware and Eastman (1977). For example,

transactional leadership is found in bureaucratic organizations (Burns, 1978) and this is the type

of structure currently found in many healthcare organizations, including aging services facilities

such as nursing homes. Such an environment is characterized by top-down decision making,


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management by exception, disempowering strategies and lack of innovation. Low trust is also

found in purely transactional cultures (Kirkpatrick & Locke, 1996; Podsakoff et al., 1990).

The retention dilemma in aging services will have a significant negative impact on the

field. To reverse the negative trend, new cultural models have been developed, engendering

better communication, a sense of empowerment and organizational trust. These models need to

be implemented and sustained by leaders capable of transforming healthcare and aging services

organizations from bureaucratic and authoritarian institutions to work environments where

employees want to stay and grow their careers over time.

Background of the Study

The organization selected as the focus for the proposed research is a leading provider of

housing and services for the aging in four states, employing nearly 4,000 persons, with 300 of

the workforce holding managerial level/supervisory positions. The annual overall staff turnover

rate is about 30%, which is significantly below the industry average. In one of the organizations

communities, turnover dropped from 74% to less than 10% within a year (K. Roberts, personal

communication, June 13, 2006). The provider organization to be examined has received

numerous awards for innovation and positive employment practices. For instance, the

organization was named Best Place to Work in an annual metropolitan survey of employees

for 2 consecutive years, in 2005 and 2006. The CEO took over the reins of the organization in

January 2003, succeeding an individual whose management style was considered authoritative

and transactional by board members. The new CEO was hired because she was perceived as a

transformational change agent. The CEOs efforts at the provider organization have resulted in

both financial and operational success. The CEO and management team are credited with


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empowering front line workers and encouraging innovation in their work (Does your workplace

have soul?, 2005).

During this CEOs tenure, innovation became a paramount value organizationally. The

staff at one of the provider communities started a catering service that serves the retirement

community as well as the greater community, netting $34,000 in operating income for the parent

provider organization. In the same organization, a 3-year education program that prepares

certified nursing assistants (CNAs) to become licensed practical nurses (LPNs), is heralded as a

model career pathing program in the aging services field. Another example of innovation is a

holistic approach to helping residents and families deal with the death of loved ones. A

maintenance worker at another senior center operated by the provider organization

conceptualized how to put electrical systems, furnaces and medical equipment online so that

crews can monitor them by computer and cell phones. These innovations or intra-preneural

ideas initiated by front line staff are shared with other staff members through a Website

accessible to all employees. In addition, a program recognizing innovative ideas has been

established.

Statement of the Problem

The provider organization in this study stands out in the field of aging services because it

represents a unique approach to leadership in an aging services organization. There are an

estimated 5,600 not-for-profit aging services providers in the United States. They are largely

viewed by consumers, the press and Congress as being in need of deep systemic change (Pioneer

Network, 2005). According to the Pioneer Network, relationships and person-centeredness are


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the fundamental building blocks of the transformed culture of the future and the promotion of

growth and individual development, a foundational value.

Culture change initiatives introduced to the field of aging services, such as the Pioneer

Network, The Wellspring Model, Greenhouse Project and Eden Alternative, have focused on

resident-centered care and empowerment of the staff who serve residents. These culture-change

programs and initiatives are designed primarily to work within an existing organizational and

leadership structure. The board of directors of the provider organization in this study has hired

from outside the aging services field an individual with a history and reputation for transforming

organizations. One question is whether the approach of hiring from outside the field has been a

successful one from the perspectives of the provider organization board members, the residents,

the community at large, and direct care supervisors and staff. If it is a successful approach in the

view of these stakeholder groups, a cogent argument can be made for approaching deep culture

change through the avenue of developing a leadership style other than the one traditionally found

in aging services provider organizations. Stone (2003) argued that there is no recipe for

organizational culture change. There is no perfect model of organizational and culture

change (p. 413). Therefore, the concept of changing the culture by changing the leadership

styles of those at the helm is a worthy topic for exploration.

Purpose of the Study

This research study utilizes a case study approach to better understand the role of

leadership in aging services organizational culture change. Research results identify that the

existence of specific leader characteristics has played an important role in changing the culture of


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an aging services environment. The research also identifies how these characteristics interface

with existing leadership theories.

Rationale

Eisenhardt (1989) made an argument that case study is ideally suited for knowledge

creation leading to theory-building. Because case study emphasizes detailed contextual analysis

of a limited number of events, conditions and their inter-relationships, it is useful in providing

the application of ideas to the real world. Yin (1984) wrote that case study is especially useful

when the boundaries between phenomenon and context are not clearly evident (p. 23).

Multiple data collections are used in case study research, and methods that employ both

qualitative and quantitative datasets as well as other sources of information, allow for a robust

substantiation of constructs and hypotheses.

Thyer (2003) utilized a case study method to compare the effects of transactional and

transformational leadership on health care teams in a hospital setting. She found that direct care

staff members were able to ignite creativity and problem-solving skills under a transformational

culture because of the trust that exists between leader and team members. Laschinger, Almost,

and Tuer-Hodes (2003) conducted nursing case studies that link structural empowerment to

factors identified as important to retention, including job satisfaction. Buerhaus, Staiger, and

Auerbach (2000) concluded in their case study work that creating conditions that empower

nurses and direct care staff fosters an atmosphere of respect that attracts and retains a sustainable

workforce in healthcare settings. Based on research involving 159 interviews and 100 hours of

direct observation in a hospital environment, Eaton (2001) discovered that five managerial


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practices characterize environments with lower turnover and better retention of nursing staff.

Heading the list was high quality leadership.

Research Questions

This research study will use a case study approach to understand the relationship among

leadership style, empowerment, and culture in an aging services organization. Several research

questions will be explored to facilitate this understanding.

1. How are the leadership style(s) of the CEO and the top management team describedby key stakeholders of the organization? Is the leadership style identified by thesestakeholders one that utilizes empowerment to affect culture change within theorganization? What are the specific behaviors exhibited by the CEO and topmanagement team in their leadership styles? Can these behaviors be matched to theconstructs of one or more leadership style models?

2. How do selected stakeholder groups associated with the provider organization defineempowerment, and do they believe it exists within the organization? Why do theybelieve or not believe that empowerment exists within the organization? Ifempowerment does exist from their perspectives, how has it contributed (if at all) tocreating a culture of retention? What do the CEO and top management team perceivethey are doing to empower members of the organization, and what do they believehas been the impact? Is there evidence that points to the existence of empowerment

within the organization?

3. How is the current organizational culture described by the various stakeholder groupsof this provider organization? Is there alignment evidenced in their perceptions? Towhat degree do the stakeholders view the leadership style of the CEO andmanagement team as contributors to the organizational culture? How has the cultureevolved since the time when the previous CEO/management team left the providerorganization? In which specific ways has this evolution occurred?

4. What lessons can be learned from this case study and potentially applied to otheraging services providers who are attempting to implement deep culture change for the

purposes of better staff retention? What other research questions deserve explorationin the future?


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Significance of the Study

Eaton (2001) concluded that even in a complex system, one person could make a vast

difference (U. S. Department of Health and Human Services, p. 9), contributing to reduction of

turnover and better retention of direct care staff. Taylor (2004) reported that leaders and their

skill in building a climate of retention, a culture that speaks to employees in a way that

encourages them to stay, will be an organizations best defense against unwanted turnover.

Leaders are the secret weapon in keeping valued talent longer (p. 43). Leadership is believed to

be a critical success factor in the culture change movement, which is seen as necessary to gain

the publics trust of aging services providers in the United States. In fact, the American

Association of Homes and Services for the Aging (AAHSA), the largest professional association

representing non-profit aging services providers, has declared this time as the era of leadership

in our field. The association recently instituted a program entitled Leadership AAHSA, the focus

of which is to identify and train emerging leaders. In the field of aging services, there is

widespread support for leadership styles emphasizing empowerment, communication,

collaboration and individual relationship-building may contribute to a culture of retention (Stone

& Wiener, 2001). Three leadership styles that emphasize some or most of these behaviors and

activities include transformational leadership, servant leadership and Level 5 leadership (Popper,

2004).


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Definition of Terms

Aging services.Provider organizations who offer one or any combination of the

following services: senior housing, adult day care, assisted living, skilled nursing, home health

care to the elderly, hospice, and rehabilitation services for the aged.

Provider organization.The organization that provides aging services to senior

populations. A provider organization can be a single site facility (such as a nursing home) or a

multi-site organization offering many types of services for seniors under one corporate umbrella.

Culture.Schein (2004) defined culture as a pattern of shared basic assumptions that was

learned by a group as it solves its problems of external adaptation and internal integration (p.

17).

Culture of retention.Manion (2004) interviewed nurse leaders who defined a culture of

retention as the creation of a work environment where people want to stay; a culture of

engagement and contribution (p. 30).

Direct care staff.Employees of healthcare organizations, such as hospitals and aging

services providers, who deliver direct care to patients and residents. These individuals include

certified nursing assistants (CNAs), licensed practical nurses (LPNs) and registered nurses

(RNs).

Empowerment.Conger and Kanungo (1988) defined empowerment in terms of a

relational dynamic: a process whereby an individuals belief in his or her self-efficacy is

enhanced (p. 474) through interaction with his or her leader.

Level 5 leadership.Jim Collins (2001) developed this description of leadership based on

a paradoxical blend of personal humility combined with professional will. This leadership style


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is intended to move organizations from being merely good to achieving sustained greatness, and

places emphasis on accountability and discipline.

Psychological empowerment.Spreitzer (1995) stated that it is a psychological state that

employees must experience for empowerment interventions to be successful. The four

components of this type of empowerment include meaning (congruence between job

requirements and beliefs); competence (confidence in ones own abilities); self-determination

(feelings of control over ones own work/autonomy) and impact (the sense of being able to

influence important outcomes within an organization).

Servant leadership.A leadership style conceptualized by Robert Greenleaf (1991) that

emphasizes 10 leader behaviors: listening, empathy, healing, awareness, persuasion,

conceptualization, foresight, stewardship, commitment to the growth of people, and building

community.

Structural empowerment.Kanter (1993) defined structural empowerment as access to

organizational structures that enable employees to accomplish their work in meaningful ways.

Specifically, Kanter listed access to formal and informal power, opportunity, information,

support and resources as the linchpins of structural empowerment.

Transformational leadership.The type of leadership that transforms individuals and,

consequently, their organizations. Transformational leadership, according to Bass and Avolio

(1993), rejects the status quo and fosters a culture of creative change and growth through the

empowerment and development of followers. The constructs of this model include: idealized

influence, inspirational motivation, intellectual stimulation and individualized consideration.


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Assumptions and Limitations

Assumptions made by the researcher included the expectation that accurate and truthful

answers to questions posed by the researcher were provided by interviewees and focus group

participants and that written documents provided by the provider organization were delivered in

their original form and not altered. Also, it was assumed that the sample of employees

interviewed were representative of other employees at the organization. Because a single case

study was the focus of this research, a limitation of the study is its generalizability to other aging

services provider organizations. Researcher bias is another limitation of the study. The researcher

has worked as a consultant to the field of aging services for 25 years. Hence, certain

preconceived notions exist due to familiarity with this field and provider organizations within the

field. The researcher took steps to mitigate this bias, including peer review, triangulation of data

and member checking strategies.

In addition, the researcher was mindful of the phenomenon discussed by Yin (1994)

regarding the danger of placing too much emphasis on a subunit of the embedded case study.

While one campus received more attention than the others due to its exceptionally low turnover

rate, the researcher visited three other campuses of the organization, and found that in two of the

three, culture change had taken root in a deep and systemic way.

Nature of the Study or Theoretical/Conceptual Framework

According to the Institute for the Future of Aging Services, the replacement cost of a

nursing assistant was $3,840 in 2001. Given that the typical aging services organization

experiences a 50% annual turnover rate, the industry cost to recruit and hire new staff to fill

vacant positions is estimated at $4 billion annually. Finding even a partial answer to the turnover


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rate issue and how to stem it would benefit the aging services field in a profound way by

lowering costs and achieving greater levels of efficiency. Hollinger-Smith, Holmes, OSullivan,

and Ortigara (2003) found significant improvements in nurse turnover rates after instituting a

program entitled Learn, Empower, Achieve and Produce, a culture change initiative that

reduced LPN and RN turnover by 20% and CNA turnover by 39% over a 1-year period of time.

This initiative emphasizes organizational learning and empowerment as two key foundational

elements.

Researchers suggest that the exorbitantly high turnover rates in aging services

organizations stem from the types of individuals attracted to the field. For example, Lescoe-Long

(1998) found that poor interpersonal skills and lack of mutual empathy among nurses aides and

their nurse supervisors affected communication, interfered with informal teamwork and were a

root cause for turnover for both aides and nurses. Training in interpersonal skills was

recommended for both nurses and aides as a result of this study.

The Kansas Association of Homes and Services for the Aging (2003) reported that a

sense of cynicism toward ones fellow human beings was evident among lower-level employees

in aging services organizations. These feelings are characteristic of people who have

experienced a great many hard times and disappointments. The cynicism suggests a lack of trust

of the motives of others and may well have affected participants willingness to fully embrace

the interventions teachings (p. 13). This finding reflects the belief that a certain percentage of

individuals coming into the field are by nature poor communicators, cynical, and untrusting of

others. Adding to this, there may be mistrust or miscommunication among the four generations

of workers that now populate the aging services workplace. These generations include


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Traditionalists, Baby Boomers, Gen Xers, and the Millennial Generation (Lancaster & Stillman,

2002).

The Institute for the Future of Aging Services (2003) conducted research concluding that

stress is overwhelming to people in the field of aging services, resulting in burnout, a prime

contributor to high turnover rates. The Institute noted in its report that there was high agreement

with these statements among those participating in its landmark turnover study:

I work under a great deal of stress.

I have too much work to do to do a good job.

I always feel I am racing from one thing to the next.

The people in my department are expected to do too much work.

The people in my department have more work to do than people in other departments.

In summary, the turnover rate in aging services could be due to any number of factors

including: a transactional culture that disempowers workers, poor leadership at the top and at the

supervisor level of the organizations, the untrusting and cynical nature of the individuals

employed by the field and/or burnout associated with stress experienced on the job. For the

purposes of this study, the researcher will focus on the relationship between leaders and their

followers, attempting to understand whether the dynamic of empowerment is present, and if so,

how this dynamic impacts the organizational culture. On the next page is a visual of the

conceptual framework for the study, outlining the variables that were initially examined by the

researcher.


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Figure 1. Researchers original conceptual framework.

Organization of the Remainder of the Study

Chapter 2 reviews the relevant literature and research impacting the study. Chapter 3

outlines the methodology employed in the study. Chapter 4 presents an analysis of the findings

of the research. Chapter 5 consists of conclusions as well as recommendations for future

research.

Empowerment:Access to organizational

structures that enable employeesto accomplish work in meaningful

ways.(Kanter, 1993)

Organizational Culture:Pattern of shared basicassumptions learned as

a group solves it problems ofexternal adaptation and internal

integration(Schein, 2004)

Leadership Style:Transformational

ServantLevel 5

Intervening variables:1. Nature of direct care

workforce: poorcommunicators, cynicaland untrusting.

2. Stress and staffingshortages, leading toburnout.

3. Generationaldifferences which causemisunderstandings.


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CHAPTER 2. REVIEW OF THE LITERATURE

A review of the literature was conducted to determine what is already known and what is

not yet known about the connection among leadership styles, empowerment and the development

of a culture in aging services provider organizations. The literature review also serves to assist

the researcher in the development and refinement of theory, as constant comparison with the

emerging data is expected to create new ideas and concepts. Since the relationship among

leadership style, empowerment, and culture is a multi-faceted and complex phenomenon, the

researcher will examine each of these dimensions in the literature review.

Rationale for the Research

The rationale for the research revolves around the importance of leadership styles that

empower workers so that organizational cultures support workforce retention in the field of

aging services. Scholars (Kanter, 1993; Manion, 2004; Taylor, 2004) posit that cultures of

retention are engendered primarily by leaders and the structural empowerment they create within

the organizations they lead. Uncovering the particular style of leadership and prominent

leadership characteristics is conducive to retaining desired talent in aging services organizations,

and eliciting the highest amount of creativity and innovation from this talent will be of vital

importance to the field in the coming decades.

The aging services field, which is predicted to achieve unprecedented levels of growth

and a much higher demand for direct care personnel over the next 20 years, has seen the

introduction of numerous person-centered culture models recently, including Wellspring,


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Greenhouse Project, Eden Alternative, and the Pioneer Network Model. Yet, it is widely known

that nurses in all healthcare fields are leaving (Laschinger et al., 2003) with an average annual

turnover rate hovering at 50% and a persistent 5% vacancy rate. It costs $4 billion annually in

recruitment and training expense just to keep enough nurses on the floor of long-term care

facilities. With the time and costs of maintaining the status quo, little emphasis is placed

leadership development. Yet without it, culture initiatives will fail. Most aging services

communities continue to operate under a transactional leadership model, despite evidence that

direct care givers respond more favorably to a transformational leadership style (Thyer, 2003).

In the report Who Will Care For Us?(Stone & Wiener, 2001), it is noted that in the

1980s several small, qualitative studies of nursing assistants identified the organizations

management style (e.g., supervisors with good people skills, promotion of worker autonomy) as

the most important predictor of higher job satisfaction and lower turnover rates (p. 5). Another

study (Konrad, 1999) found that when nurse supervisors accepted nursing assistants advice or

simply discussed care plans with the aides, turnover rates dropped by a third. These findings

strongly point to the positive effect of empowerment in the aging services workplace. The

rationale for the proposed research, then, is to understand howleadership is connected to

empowerment and whether other leader characteristics facilitate cultures that encourage workers

to stay in the aging services workplace.

Theory Generating the Question and Exploring the Foundations of the Field

The primary research question to be explored in this study is: Can a culture change, with

an emphasis on retention, be created by a certain type of leadership style in aging services

organizations? And if so, what are the specific behaviors and characteristics associated with such


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a leadership style? The question touches upon empowerment theory, leadership theory, and

culture change theory, and requires a deep familiarization with each theme area.

Theme Area 1: Empowerment Theory

The concept of empowerment has been widely adopted in nursing research (Kuokkanen,

Leino-Kilpi, & Katajisto, 2003) as a strategy for attracting young people and retaining nurses

currently working in the healthcare fields. Within the nursing field, Kanters (1977, 1993)

empowerment theory has been used as a basis for research to understand how this concept

influences organizational trust, job satisfaction and organizational commitment. Kanter (1993)

posited that access to information, support, resources and the opportunity to learn and develop

are empowering to nurses, influencing their work attitudes and productivity. Kanters notion of

structural empowerment is based on the idea that workplace environments and leadership style

have a greater impact on employee attitudes and behaviors than personal predispositions

(Laschinger & Finegan, 2005, p. 6).

Several studies of nurses have linked structural empowerment to factors identified as

important for retaining nurses (Kutzcher, Saviston, Laschinger, & Nish, 1997; Laschinger,

Almost, & Tuer-Hodes, 2003; Whyte, 1995). Wilson and Laschingers (1994) work concluded

that administrators in healthcare settings can empower their staff and thus improve

organizational commitment by manipulating the structures in the work environment to allow

greater access to the power and opportunity structures that Kanter (1977) maintains are important

to overall work effectiveness. More recent research by Laschinger and Finegan (2005)

concluded: Work settings which are structurally empowering are more likely to have

management practices that increase employees feelings of organizational justice, respect and

trust in management (p. 7). Manojlovich (2005) studied the interaction between structural


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empowerment, leadership and self-efficacy for nursing practice to determine if self-efficacy

contributes to more professional nursing behaviors. The researcher argued that opportunities for

role modeling and verbal persuasion did improve practice behaviors as well as job satisfaction.

Barry, Brannon, and Mor (2005) used an adaptation of Kanters theory of structural

empowerment to guide the framework for their study on nurse aide empowerment strategies and

found it led to nurse aid staff stability. Kane-Urrabazos (2006) study of managements role in

shaping organizational culture led the researcher to determine that leaders influence in creating

positive workplace environments can increase employee satisfaction, impacting turnover rates

positively. Identified in this study were four critical components of a culture conducive to

retaining workers: trust, empowerment, consistency and mentorship. However, Spreitzer (1985)

found that employees must possess psychological empowerment, a psychological state that

allows empowerment interventions to be successful.

Empowerment, at both the structural and psychological levels, has been linked through

previous studies to culture change. Conger and Kanungo (1988) wrote: Empowerment may

prove to be a vital form of influence for leaders attempting to induce and manage organizational

culture change (p. 480). One purpose of the research proposed is to identify whether

empowerment exists at the provider organization being studied, and if so, how it is defined by

direct care workers and their supervisors.

Theme Area 2: Leadership Style Theory

Northouse (2004) lists more than 35 identifiable styles of leadership developed by

scholars over the past 50 years. The more recent styles emphasize relationship over task and are

based on the belief that leaders are not born, but rather have the ability to learn relationship skills

(p. 3). Three of the most prominent and popular affective leadership styles today are


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transformational leadership, servant leadership and Level 5 leadership, all belonging to the New

Leadership paradigm originally identified by Bryman (1992). The New Leadership paradigm

favors leadership styles that focus on relationship-building between leaders and their followers,

requiring an emotional involvement that did not typify earlier leadership styles, such as those

based on the Great Event or trait approach theories.

Transformational Leadership

Transformational leadership, first introduced by Burns (1978) and later conceptualized by

Bass and Avolio (1990), consists of four constructs known as the Four Is: idealized influence,

inspirational motivation, intellectual stimulation and individualized consideration. These

constructs, when actualized in behaviors by the leader, are believed to contribute to followers

self efficacy and, in turn, help them connect more deeply to the organizational mission and

vision. Through this connection, the follower is able to achieve more than originally thought

possible and is motivated to help transform the organization to greater heights.

Tichy and DeVanna (1990), in their study of transformational leaders, identified the

specific elements that cause an organization to journey from the status quo to transformation.

The core element is the need for the leader to help followers recognize the need for

change. This typically is accomplished by pointing out to followers how changes in external

forces could positively or negatively affect the organizations future. Leaders encourage dissent

and argument to question the organizations basic assumptions, at times playing the role of

devils advocate to encourage alternate ways of seeing the same problem. Another technique

involves the use of objective assessment to determine whether the organization is meeting its

established goals and to identify the best practices employed by other organizations. By shifting


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the basic paradigm of the organization from the status quo to how can we be better? the leader

acts as change agent.

The next phase of the change process is vision creation. While the leader begins with an

overall concept of what the organizational vision can be, followers are encouraged to participate

in developing a conceptual roadmap of what the organizations future will look like.

Following this phase comes the process of breaking down old structures and establishing

new ones. It is during this phase that transformational leaders often put in place new coalitions of

employees compatible with the new vision. A key element of these teams is empowerment,

which involves power-sharing between leaders and followers, and is characterized by

independent decision-making on the part of subordinates. Shamir, Zakay, Breinin, and Popper

(1998) suggested that by having high expectations of followers and showing how the

organization has confidence in their abilities, transformational leaders are instrumental in

positively impacting worker self-esteem. This self-esteem, in turn, contributes to organizational

learning because employees feel more freedom to experiment and make mistakes. In allowing

the followers creativity and innovative ideas to blossom, the transformational leader encourages

them to feel ownership of the vision as well as the organization as a whole. By empowering

followers to find new ways of approaching old problems and welcoming opposing points of

view, the transformational leader ingenerates feelings of trust and tolerance (Avolio & Gibbons,

1988). This infrastructure allows for the organizational seismic shift that is required for

organizational culture change to take place. The movement takes place at three levels

individually, structurally and climatically (Lewin, 1948).

The final stage of the cultural transformation is refreezing the organization so that the

institution of new patterns of individual behaviors, systems and climate occurs. For example, the


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refreezing process could result in new recruitment practices to ensure individuals hired within

the organization are open and receptive to change. It might also involve the adoption of a new

reward system for employees who exhibit desirable operating norms at the structural level.

Climatically, the changed organization may adopt a new vision that emphasizes participative and

open management styles. Such transformations require commitment and courage on the part of

the leadership.

The four constructs of the transformational leadership model as conceptualized by Bass

and Avolio (1990) each play a part in helping the leader to transform the organization. While

transactional leaders work within the existing culture of an organization, transformational leaders

reject the status quo, fostering a culture of creative change and growth through the empowerment

and development of their followers.

According to Bass and Avolio (1993), the characteristics and qualities of an

organizations culture are taught by its leadership and eventually adopted by its followers (p.

113). The transmission of a new culture occurs through specific leadership behaviors, namely the

Four Is of transformational leadership (Avolio, Waldman, & Yammarino, 1991).

In a transformational culture, a general sense of purpose is articulated by a strong mission

statement. In addition, theidealized influence construct of the model emphasizes the importance

of role-modeling by the organizations leaders. This role-modeling helps socialize new members

into the culture by demonstrating high standards of virtuous behavior. The organization is guided

by a compelling vision, which is strongly articulated by the leadership, but is also strongly felt

and owned by the organizations followership. Vision is central to the transformational leaders

work because it mobilizes followers to set goals and achieve them. The vision not only


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articulates the organizations future direction, but also clarifies the organizations identity and

how individuals fit within its context.

By providing a sense of meaning and connecting an individual workers role to the

overall vision of the organization, the transformational leader motivates followers. This

inspirational motivationprovided by the transformational leader causes followers to believe they

have a significant part to play in achieving the vision. It compels followers to optimize their

abilities and contributions. In contrast, the transactional leader is focused on contingent reward

and management by exception that does little to motivate workers to be all they can be for

their own development and the good of the organization. Therefore, workers in a transactional-

based working environment are motivated not by a compelling vision but rather by rewards,

whether they be monetary or in some other form of exchange. Commitments in such an

environment are short-lived and each worker is more concerned with his or her own day-to-day

tasks than the larger picture of the organization. Employees in the transactional environment

work independently and cooperation is dependent upon negotiation. Therefore, little

identification exists with the mission or the vision, and leaders are seen as little more than

brokers of resources. Flexibility, discretionary behavior or creativity is rarely found in a highly-

transactional environment, and the culture rarely changes. Although transactional cultures are

focused on maintaining or achieving acceptable standards of performance, the modus operandi is

to sustain the status quo, not to challenge it.

Transformational leaders who employ inspirational motivation, on the other hand, are

very intent upon providing challenge to workers. According to Avolio, Waldman and

Yammarino (1991), transformational leaders strongly support a lifespan model of self-

development and development of others and thrive on and seek out challenges throughout life


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(p. 12). This challenge-seeking psychographic dimension of leadership explains why

transformational leaders are successful in drawing others to them who are also challenge-driven

and willing to take intellectual risks. To transform others, the leader accepts and recognizes the

need to first transform herself. When others see this willingness on the part of the leader, they are

more inclined in turn to grow and develop. Part of this willingness involves risk-taking and

challenge-seeking. In fact, research has demonstrated that transformational leadership can be

developed at the lower levels of an organization when those individuals are exposed to the

behaviors of transactional leaders at the higher levels (Bass, Waldman, Avolio, & Bebb, 1987).

Intellectual stimulationis another aspect of the transformational leadership model that

fuels organizational culture change. As mentioned earlier, organizational learning is a key

component of this construct. Leaders who intellectually stimulate others cause followers to re-

examine their basic assumptions and change the way they think about problems, both technical

and human resource-related. An intellectually-stimulating leader encourages followers to look at

issues with a new lens and is willing to challenge his or her own previously-held assumptions

when workers bring new information and ideas to the leader. As a result of being intellectually

stimulated, followers develop their own ability to creatively problem-solve over time, causing

the very culture of the organization to become more open, flexible, and innovative.

The individualized considerationconstruct of the transformational leadership model

recognizes the need to treat each individual employee as a unique and valued being. Leaders

employing this characteristic listen to and share followers concerns while assisting with

confidence-building. By acknowledging and responding to individual worker needs,

transformational leaders garner the resources necessary to help individuals succeed and thrive in

the workplace, removing roadblocks to success and serving as advocates when required. By


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nurturing their followers, leaders are able to help them achieve their optimum potential, which in

turn contributes to the overall change in culture of the organization. Followers become more

transformational themselves, because their needs are being met and they are now able to focus

more fully on the needs of their own subordinates. The process is best characterized as leaders

developing leaders, according to Avolio et al. (1991, p. 15).

Through employment of the Four Is, transformational leaders realign the values and

norms of their organizations while promoting internal and external change. Through role

modeling, visioning, challenging and intellectually stimulating followers, such leaders are able to

inspire others to change themselves, and thus change the organization. Schneider, Brief, and

Guzzo (1996) state that organizations as we know them are the people in them; if people do not

change, there is no organizational change (p. 7). Transformational leaders develop relationships

with followers so that they feel nurtured and valued, creating a safe environment conducive to

personal and corporate levels of change and growth. Bennis and Townsend (1995) refer to this

phenomenon as ACE: acknowledge, create and empower.

Tichy and Ulrich (1984) stated that transformational leaders create something new out of

something old and that their followers are taught to learn from the past instead of lamenting over

previous mistakes. They begin to act out fresh scripts instead of stale ones, freeing their creative

juices. In essence, it is this teaching that allows followers to embrace the change their leaders ask

them to embrace. Therefore, the connection that bridges transformational leaders and culture

change is empowerment through organizational learning: the ability of the leader to teach

individuals how to change themselves, using the leader as role model and supporter of the

change process. As posited by Tichy and Ulrich (1984): The transformational leader needs to


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articulate new values and norms and then to use multiple change levers ranging from role

modeling, symbolic acts, creation of rituals to support new cultural messages (p. 67).

Each of the constructs of the transformational leadership model supports this notion of

the leader as teacher, whether in the form of role model, vision articulator, motivator, interpreter,

mentor, coach, intellectual stimulator or empowering nurturer. Bryant (2003) states that the

transformational leader is more effective in creating and sharing knowledge at both the

individual and organizational levels than are more traditional leaders. Because leaders provide

the context in which workers create knowledge and determine how work is valued within the

organization, they influence worker motivation to develop new knowledge. By creating a climate

receptive to new ideas, transformational leaders open the gates of change.

Servant Leadership

Servant leadership is often referred to as values-based leadership and places a high

premium on ethics and authentic behaviors. Introduced by Greenleaf (1991), servant leadership

is a style emphasizing teamwork, community, democracy and humanism. The 10 key

characteristics are associated with this leadership style are: listening, empathy, healing,

awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of

people, and building community (Spears & Lawrence, 2004).

Listening pertains not only to listening to the voice of followers, but also to the internal

voice of the leader himself or herself. Listening is an essential part of communication. It is

estimated that 45% of organizational energy is dissipated due to misunderstandings between

supervisors and their subordinates, with two out of every three mistakes occurring due to

miscommunication (DeGraaf et al., 2004).


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Empathy is the capacity for understanding another individuals ideas or feelings. Albrecht

and Zemke (1985) refer to empathy as moments of truth that enhance relationships between

supervisors and their subordinates as well as employees and their customers.

The spiritual dimension of servant leadership is manifested in the healing characteristic.

As problems and crises occur in the lives of employees, leaders are called upon to take an active

role in helping their subordinates heal their wounds and become whole once again through the

encouragement of the leader. They understand that their key task is to create and maintain a

positive environment in which people are motivated to work, according to DeGraaf et al.

(2004).

Awareness is the leadership characteristic that calls for regular self-reflection, as well as a

knowledge of the needs of those who the leader serves. Covey (1989) emphasized the

importance of self-examination and of keeping the end in mind. By this he means it is critical to

know what values the leader holds as important, so that decision-making can more readily

happen. Alignment between the leaders own values and the content of decisions made is of

paramount importance.

Persuasion, used appropriately and not in a coercive manner, is another dimension of

servant leadership. The concept of persuading others within this context relates to

communicating the value of a product or service to others so that they understand clearly how it

will benefit their lives (DeGraaf et al., 2004).

Conceptualization is related to the systems-thinking construct found in Senges (1990)

organizational learning model. The ability to view phenomenon holistically, seeing the forest

through the trees, and inductive reasoning are embedded in conceptualization.


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Foresight, a close cousin of conceptualization, is the ability to know where to head next.

Leaders must be sensemakers and visionaries for their organizations, but do so within the context

of empowermentand teamwork as co-creators of the future (DeGraaf et al., 1994, p. 151).

Accountability and shared power are the underlying constructs of stewardship, as

envisioned by Greenleaf (1991). Stewardship is not limited to, but includes, an association with

the environment and financial responsibility. Block (1996) referred to stewardship as the orderly

distribution of power. The concept is tied to empowermentand trust.

Commitment to growth of people is another hallmark of servant leadership, as it

underscores the importance of mentoring and intellectually stimulating others. Building

community, the tenth and final characteristic identified as crucial to servant leadership, is tied to

social accountability and the need for leaders and their organizations to be mindful of the needs

of their communities. Enhancing the quality of life for both employees, customers and the greater

society is a focus of community-building (Greenleaf, 1991).

Level 5 Leadership

Level 5 leadership as conceptualized by Collins (2001) is described as a skillful blend of

professional will and personal humility. Self-effacing, quiet, reserved, shythese leaders lead

their organizations from good to great through a fierce resolve to channel their energy into the

vision, not into their own egos. Collins (2001) wrote: Given that Level 5 leadership cuts against

the grain of conventional wisdom, especially the belief that we need larger than life saviors with

big personalities to transform companies, it is important to note that Level 5 is an empirical

finding, not an ideological one (p. 22).

Collins (2001) work heavily promotes the notion of empowerment, advocating that

leaders should build a culture around the idea of freedom and responsibility (p. 124). However,


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unlike the transformational and servant leadership models, Collins conceptualization is that

empowerment strategies will not be successful unless the right people are employed by the

organization. In other words, those who lack internal motivation will likely not change even if

they are empowered by their leaders. He maintains that once these intrinsically motivated

workers are engaged in work they are passionate about with co-workers and leaders who earn

their respect, the employees will thrive in their workplaces and take their organizations to

greatness. Collins (2001) notion of intrinsic motivation dovetails with Spreitzers (1995)

concept of psychological empowerment, a psychological state that employees must experience

for empowerment interventions to be successful.

The three leadership styles of transformational, servant and Level 5 have strong

theoretical underpinnings related to empowerment and culture change. The purpose of the

research was to explore the leadership style of the CEO and management team at a provider

organization and examine whether the characteristics identified have a relationship to

organizational transformation.

Theme Area 3: Organizational Culture Change

The definition of culture is somewhat elusive, according to Lewis (1994). There is no

consensus of opinion about what organizational culture really is, a problem that occurs when a

term is borrowed from another discipline. Culture originated in the field of anthropology

(Meek, 1988). Some authors see culture as intangible shared meanings and basic assumptions.

Others, like Lewis (1994), define culture as the feelings, beliefs, values and basic assumptions

held by members of the organization, either collectively or individually, as they relate to work

activities (p. 43). Allaire and Firsirotu (1984) state that how individuals view organizational

culture will determine how one studies it. In fact, Schein (1992) found that ones view of culture


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also determines how a leader goes about changing it. Thus, different researchers posit different

ways to change the culture of an organization.

Kurt Lewin (1948), a pioneer in the field of social psychology of organizations, identified

three phases of change: unfreezing, moving, andrefreezing. According to Lewins change model,

organizations are like living creatures; that is, they tend to be homeostatic, or continuously

working to maintain a steady state. This open-systems view helps explain why organizations

require external impetus to initiate change and why that change will be resisted even when it is

necessary (Goodstein & Burke, 1991). According to Goodstein and Burke (1991), organizational

change occurs at three levelswithin individuals who work at an organization, through

organizational structures or systems, and through the organizational climate or interpersonal style

of interaction among employees (p. 10).

Lewin (1948) believed that the first step of any culture change process is to first unfreeze

the present pattern of behavior as a way of managing resistance to change. Depending on the

organizational level of change required, this unfreezing process may involve anything from the

selection of new organizational leadership to the termination of resistant employees. At the

structural or systemic level, the unfreezing may involve the development of new organizational

designs such as matrix management. At the organizational climate level, it could involve the

adoption of a learning environment whereby dialogue and other techniques are utilized (Issacs,

1993).

The second stage of Lewins model is movement, which consists of making the actual

changes required to impact a new culture. For example, at the individual level, this may mean the

adoption of new supervisory interaction techniques. Structurally, a new performance appraisal


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system could be put into place. Climatically, new levels of trust and openness could be

encouraged by management with employee groups.

The final stage of the culture change process, refreezing,involves stabilization or

institution of the new patterns of individual behaviors, systems and climate. For instance, the

refreezing process could manifest itself in new recruitment practices to ensure individuals hired

in the future are open and receptive to change; the adoption of a new reward system for

employees who exhibit certain operating norms and a vision that emphasizes participative and

open management styles.

Goodstein and Burke (1991) posited: Changing behavior at both individual and

organizational levels means inhibiting habitual responses and producing new responses that feel

awkward and unfamiliar to those involved. It is all too easy to slip back to the familiar and

comfortable (p. 14). The culture change process, then, typically requires courage and

commitment of top management. Goodstein and Burke (1991) concluded that an understanding

of social psychology of the change process is implicit to success.

Schneider et al. (1996) posited that different leadership styles create certain types of

social climates that affect productivity in specific ways. People are nearly equally productive

under democratic and authoritarian leadership styles, but they work much more harmoniously

and are more satisfied under a democratic leader (p. 9). These authors differentiated between

organizational climate and organizational culture, terms frequently used interchangeably in the

culture literature, by stating because organizational culture concerns the firmly implanted

beliefs and values of organizational members, it resides at a deeper level of peoples psychology

than does climate. Culture captures a less conscious, more subtle, psychology of the workplace.

Whereas climates policies, practices and rewards are observable, the beliefs and values of


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culture are not so directly visible (p. 11). However, they also argued that culture can be changed

through a focus on climate because climate reflects the tangibles that produce a culture. It is only

by altering the everyday policies, practices, procedures and routines that change can occur and be

sustained. Schneider et al. (1996) stated: To communicate new values and beliefs requires

changing tangibles, the thousands of things that define climate, that define daily life in an

organization. Deeds, not words, are tangible (p. 12).

The organizational development perspective, which relies heavily on the works of

Abraham Maslow (1943), rests on a number of assumptions about people and their relationships

in organizations, namely: (a) people desire growth and development, (b) people value

interpersonal interaction, and (c) people need trust, support and cooperation to function

effectively. Research suggests that organizations, when they learn to operate under such

assumptions, are more open to change (Schneider et al., 1996).

To successfully change an organization, the top management team must move the

respective parts of the organization in accordance with the change, but must also model a new

climate. For example, the team may begin communicating differently and sharing resources more

freely with one another. A top management teams success in delivering sustained

improvements through system-wide change in climate and culture greatly depends on that teams

ability to arrive at a shared vision and to be uniform in its commitment (p. 18) wrote Schneider

et al. (1996).

The transformation of a company requires employees to adopt a new view of its future, a

future they need to regard as essential. Before employees can arrive at this deep conviction,

stated Day and Jung (2000), they need to understand why? and why now? requiring the skill

of a leader able to communicate those answers.


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Klein (1996) believed this type of communication skill is the primary need leaders must

address during the unfreezing stage of organizational change so that people are readied for

change (p. 37). During the unfreezing stage, the content of the communications is characterized

by explanation, rationales and reassurances states Klein (1996, p. 38). If the change is more

than marginally incremental, it is likely that the resistance, some of it strong, will surface

because old values and methods are implicitly challenged. It is because the level of resistance is

so high, that strong communication skill is required at this stage of the change process. If the

change is organization-wide, Young and Post (1993) recommended that the CEO be the main

communicator.

Jick (1995) advised that the change process takes considerable patience, stating that

changing a company and its culture can take up to seven years or longer. The challenge involves

changing the hearts, minds and habits of people, the so-called software of a company, he

wrote (p. 79). No culture change occurs without people learning new ways of behaving and

thinking. The change begins, by first changing the leader, through leadership role modeling. Jick

(1995) emphasized the need for the leader to walk the talk and display behavioral integrity

through the consistency between the walk and the talk. He further maintained that accelerating a

change process requires skill, determination and creativity. Challenging accepted paradigms of

how change is introduced and managed is also required.

Kotter (1995) clarifies the connection between culture change and leadership even more

specifically when he stated: change, by definition, requires creating a new system, which in

turn, always demands leadership (p. 60). Transformations often begin when an organization has

a new leader who sees the need for a major change and questions the status quo. Kotter (1995)

emphasized the need for powerful vision creation and communication, encouragement of risk


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taking, and non-traditional ideas, activities and actions. He also underscored the importance of

creating a coalition of believers in the need for change. Kotter (1995) additionally observed that

in failed transformations, there was evidence of plans, directives and programs, but no vision. He

added that employees will not make sacrifices, even if they are unhappy with the status quo,

unless they believethat useful change is possible. Therefore, the presence of a strong leader is

key to culture change.

Bartlett and Ghoshal (1990) explained that in the past, companies often assumed that

changing their formal structure would force change in interpersonal relationships and decision

processes, which in turn would reshape the individual attitudes and actions of managers. Today,

the impracticality of such an approach is acknowledged due to the long time span that is required

for structural changes to permeate the whole spectrum of organizational features. An alternative

starting point is to alter the broad corporate beliefs and norms that shape managers perceptions

and actions through visioning, utilization of human resource tools, and stimulation of individual

participation and thinking within the broad corporate agenda. There is also acknowledgement,

according to Jick and Peiperl (2003), of the importance of a networked organization to cultural

change. The networked organization is a concept not about formal structure, but rather about

how to put different parts of the organization and its workers in touch with each other, free of

boundaries.

Cultures of Retention in Aging Services

Laschinger and Finegan (2005) stated that an important strategy for increasing

recruitment and retention of nurses will be to create work environments that manifest justice,

trust, and respect and thereby facilitate professional nursing practice (p. 6). Manion (2004)

described a culture of retention as a workplace where people want to be (p. 39) and posited


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that organizational leadership plays a dominant role in the culture and climate of the workplace.

Thyer (2003) boldly claimed that transactional leadership styles are causing nurses to leave their

places of employment. Ideologically, she claims, nurses require a working environment led by

those who are visionary and creative, not lock-step and disempowering. Because nurses and

direct care staff comprise a significant portion of the aging services workforce, those in direct

care job positions influence the entire system of an aging services organization. Yeatts and

Seward (2000) suggested that the use of self managed work teams could reduce turnover and

improve care in nursing homes. Naude (1995) found that transformational leadership had a

positive impact with nursing unit managers in a Western Australia aged care service

organization, leading to lower turnover rates. Taylor (2004) posited:

Responsibility and accountability for retaining talent need to move out to the front linesand into the hands of leaders. Leaders and their skill in building a climate of retention, aculture that speaks to employees in a way that encourages them to stay, will be anorganizations best defense against unwanted turnover. Leaders are the secret weapon inkeeping valued talent longer. (p. 43)

The purpose of the research was to identify the current culture of the provider

organization and determine how this culture has evolved since the time the new CEO and

management team has been in place. Specifically, the study explores the relationships among

leadership style, empowerment and culture.

Summary

Leadership styles are much debated in the management literature and have been studied

using both qualitative and quantitative methods in many contexts (Northouse, 2004, p. 1).

Bryman (1992) introduced the New Leadership paradigm, which emphasized the relationship

between leaders and followers, suggesting that the affective elements of leadership could be


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successful in motivating followers. These affective elements include good communication, a

concern for the individual and his or her unique needs and qualities, and serving as a positive and

ethical role model for followers. Three prominent leadership styles emphasizing these elements

are transformational leadership, servant leadership and Level 5 leadership (Popper, 2005).

Within the aging services field, high turnover rates threaten the ability of providers to

serve an ever-growing population of seniors. Turnover, studied by numerous nursing and aging

scholars, is due to a variety of factors, including a transactional-type work environment that is

authoritative and bureaucratic in nature, placing little emphasis on relationships between

employees and their leaders. Empowerment is a central element of transformational, servant and

Level 5 leadership styles. However, little research has been conducted to determine the exact

behaviors and leadership style most conducive to creating empowerment, which Kanter (1993)

describes as a strategy that enables employees to accomplish their work in meaningful ways.

Through empowerment, leading nursing scholars (Kanter, 1993; Laschinger et al., 2003)

posit that cultures of retention (Manion, 2004) can be created in healthcare organizations.

These cultures are work environments where employees want to stay; they are cultures where

engagement and contribution occur.

The majority of research conducted to date on these topics strongly suggests that leaders

impact the ability of an organization to possess a culture of retention. However, in the field of

aging services, no research has been carried out to specifically uncover the type of leadership

style required for a culture of retention to exist and flourish.

As the population of seniors grows in the United States, so does the need for direct care

workers to provide care to those requiring it. A severe shortage of direct care workers already

exists and this shortage is expected to grow exponentially over the next decade. To attract


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workers to the field of aging services, provider organizations are implementing a number of

strategies, including the hiring of foreign-born nurses, allowing employees to work more flexible

hours and developing cultures of retention (Manion, 2004). These cultures are ones where

structural empowerment exists and enable employees to accomplish their work in meaningful

ways (Kanter, 1977). While the link between culture and empowerment has been established

through previous research studies (Eaton, 2001; Laschinger & Finegan, 2005; Stone & Weiner,

2001; Taylor, 2004), it is yet not clear what kind of leadership style is most conducive to

empowering employees so that a culture of retention is created in aging services environments.

Identifying a full-range of leadership characteristics that contribute to the creation of cultures

that encourage workers to stay in these environments will have significant impact on the field,

contributing to its financial health and its public image.


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CHAPTER 3. METHODOLOGY

Purpose of the Study

The research study employed a case study approach to better understand the relationships

among leadership style, empowerment and culture change. The case study focused on an aging

services provider organization based in the United States, where a leader and management team

from outside the field was brought into effect culture change.

Researchers Philosophy and Knowledge Claims

Case study is an ideal methodology when a holistic, in-depth investigation is needed

(Feagin, Orum, & Sjoberg, 1991). Case studies bring out details from the viewpoint of

participants by using multiple sources of data (Tellis, 1997). Although all forms of qualitative

research have the potential to contribute to theory-building, Eisenhardt (1989) made a cogent

argument that case study is ideally suited for this type of knowledge creation. Like Jick (1979),

she posited that triangulation, with its multiple sources of data, allows for a more robust

substantiation of constructs and hypotheses (Eisenhardt, 1989). Because case study emphasizes

detailed contextual analysis of a limited number of events, conditions and their inter-

relationships, it is useful in providing the application of ideas to the real world. Yin (1984) wrote

that case study is especially useful when the boundaries between phenomenon and context are

not clearly evident (p. 23).

Critics, on the other hand, claim that case study offers no grounds for establishing

generality of findings because of the small number of cas

leadership style and its relationship to culture in an aging services provider organization a case...

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