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Michele D. Holleran

A Dissertation Presented in Partial Fulfillment

Of the Requirements for the Degree
Doctor of Philosophy

Capella University
December 2006

UMI Number: 3239154

Copyright 2007 by
Holleran, Michele D.
All rights reserved.

UMI Microform 3239154

Copyright 2007 by ProQuest Information and Learning Company.
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Michele D. Holleran, 2006

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.

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


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.

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.

Table of Contents


List of Tables


List of Figures


Introduction to the Problem

Background of the Study

Statement of the Problem

Purpose of the Study


Research Questions

Significance of the Study

Definition of Terms


Assumptions and Limitations


Nature of the Study or Theoretical/Conceptual Framework


Organization of the Remainder of the Study




Rationale for the Research


Theory Generating the Question and Exploring the Foundations of the Field






Purpose of the Study


Theoretical Framework: Initial Research Questions and Objectives



Research Design


Rationale for Methodology


Sampling Design


Procedures for Consent to Participate, Participants at Risk and Confidentiality


Methods and Procedures for Data Collection, Including Researcher Participation


Data Analysis Procedures


Limitations of Methodology


Ethical Issues




About the Organization


Interviews and Focus Groups


How Data Were Coded


Open Coding of the Data


Leadership Characteristic 1: Transparency


Leadership Characteristic 2: Trustworthiness


Leadership Characteristic 3: Connectivity


Leadership Characteristic 4: Accountability


Leadership Characteristic 5: Empowerment


Leadership Characteristic 6: Optimism


Discovery of Six Connector Concepts


Conceptual Framework







Other Findings Important to Note


Application of the Conceptual Framework


Research Recommendations


How the Conceptual Framework Relates to Other Leadership Theories











List of Tables
Table 1. Participant Profile


Table 2. 2006 Nursing Home Turnover Statistics


Table 3. Leadership Characteristics Inspiring Culture Change


Table 4. Theoretical Underpinnings Associated With Identified Leadership Characteristics


Table 5. Disconfirming Evidence Noted Within Organizational Culture


Table 6. Similarities Between Constructs of Transformational Leadership



List of Figures
Figure 1. Researchers original conceptual framework.


Figure 2. The dashboard.


Figure 3. Conceptual framework of leadership characteristics and connector concepts

leading to culture change and employee retention.


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

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 transactionalbased 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

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 consensusbuilding, 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,

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

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

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

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

an aging services environment. The research also identifies how these characteristics interface
with existing leadership theories.

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

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 described
by key stakeholders of the organization? Is the leadership style identified by these
stakeholders one that utilizes empowerment to affect culture change within the
organization? What are the specific behaviors exhibited by the CEO and top
management team in their leadership styles? Can these behaviors be matched to the
constructs of one or more leadership style models?
2. How do selected stakeholder groups associated with the provider organization define
empowerment, and do they believe it exists within the organization? Why do they
believe or not believe that empowerment exists within the organization? If
empowerment does exist from their perspectives, how has it contributed (if at all) to
creating a culture of retention? What do the CEO and top management team perceive
they are doing to empower members of the organization, and what do they believe
has 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 groups
of this provider organization? Is there alignment evidenced in their perceptions? To
what degree do the stakeholders view the leadership style of the CEO and
management team as contributors to the organizational culture? How has the culture
evolved since the time when the previous CEO/management team left the provider
organization? In which specific ways has this evolution occurred?
4. What lessons can be learned from this case study and potentially applied to other
aging services providers who are attempting to implement deep culture change for the
purposes of better staff retention? What other research questions deserve exploration
in the future?

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,

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.
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
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


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
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.


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

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
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


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


Leadership Style:
Level 5
Intervening variables:
Nature of direct care
workforce: poor
communicators, cynical
and untrusting.
Stress and staffing
shortages, leading to
differences which cause

Access to organizational
structures that enable employees
to accomplish work in meaningful
(Kanter, 1993)

Organizational Culture:
Pattern of shared basic
assumptions learned as
a group solves it problems of
external adaptation and internal
(Schein, 2004)

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



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,

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 how leadership 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

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

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

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

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

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, the idealized 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


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 motivation provided 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 transactionalbased 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 highlytransactional 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 selfdevelopment and development of others and thrive on and seek out challenges throughout life

(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 stimulation is 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 reexamine 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 consideration construct 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

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


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).

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.
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.


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 empowerment and 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 empowerment and 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,

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

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, and refreezing. 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,
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


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

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.

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
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

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 believe that 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
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

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 lines
and into the hands of leaders. 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)
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.

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

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

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.


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 interrelationships, 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 cases examined using this research

method. Still others suggest that the researchers intense exposure to that which is being studied
biases his or her ability to remain objective, thereby invalidating results. Case studies also have
come under scrutiny due to the sheer amount of data generated within them, causing skeptics to
wonder whether any real sense or conclusions can be drawn from voluminous datasets. Pettigrew
(1973) for example, cautioned that too much data can be confusing and difficult to maneuver. A
salient feature of case study research is the tendency to blend data analysis with data collection,
requiring a skill level beyond what the novice researcher typically brings.
Yet despite the criticisms and misgivings, prominent management scholars such as
Mintzberg (1979) clearly value the role of qualitative research in general, and case study
methodology in particular. He wrote: Theory-building seems to require rich description, the
richness that comes from anecdote. We uncover all kinds of relationships in our hard data, but it
is only through the use of this soft data that we are able to explain them (p. 587). First and
foremost, it seeks to study phenomenon in a holistic fashion, tying it to the systems approach
outlined by Arbnor and Bjerke (1997). Other qualitative research traditions, such as grounded
theory, ethnography, narrative and phenomenology more readily fall under the actors approach
model because of their focus on individual experiences and the nuances of human behavior.
Case study can be used to generate novel theory or to generate new insights about
existing theory (Eisenhardt, 1989). Although it differs from grounded theory research, it can be
fashioned to be highly inductive and explore in-depth the boundaries between phenomenon and
context (Yin, 1984). According to Feagin et al. (1991), case studies strive toward a holistic
understanding of cultural systems.
Case study is also the methodology of choice for many researchers studying leadership
styles. Conger (1998) posited that qualitative research must play an important role no matter

what stage we are in the investigation of leadership topics. The main reason is the extreme and
enduring complexity of the leadership phenomenon itself. For the foreseeable future, there will
be no endpointa moment where researchers will be able to say that we know have a complete
and shared understanding of leadership (p. 108).
Because the research study investigated the relationship among leadership styles,
empowerment, and culture, it was appropriate to employ a systems approach to the
understanding of these relationships. The study of these inter-relationships also requires a
flexible research design, because although models have been developed for empowerment,
leadership and culture, none of them have been rigorously studied within an aging services
The researchers worldview will determine the choice of research problems, which also
determines the methodology to be used. As a conceptual theorist, the researcher who conducted
this study is an individual who uses intuitive methods of generating information, combined with
logic and analysis to reach conclusions. This notion of conceptual theorist is compatible with
interpretivism, which Gephart (1999) claimed guides the systems approach, built on the
fundamental premise that the whole is larger than the sum of individual parts and that a change
in one aspect of the system will affect the rest of the system. The systems approach, according to
Arbnor and Bjerke (1997), assumes a world of intersubjectivity, in which the parts are explained
and sometimes understood, by the characteristics of the whole. A key strength of the systems
approach is its synergistic effect whereby the content of the individual components, and the way
they are put together, provides vital information. A vulnerability of the systems approach is that
it is not possible to remove any of the factors from a systems picture without risking that the total
picture will be seriously affected.

Theoretical Framework: Initial Research Questions and Objectives

Research questions relating to empowerment, leadership style and culture were explored
utilizing a flexible design. To reiterate, the specific research questions included:
1. How are the leadership style(s) of the CEO and top management team described by
the key stakeholders of the organization? Is the leadership style identified by these
stakeholders one that utilizes empowerment to affect culture change within the
organization? What are the specific behaviors exhibited by the CEO and the top
management team in their leadership styles? Can these behaviors be matched to the
constructs of one or more leadership style models?
2. How do selected stakeholder groups associated with the provider organization define
empowerment, and do they believe it exists within the organization? If empowerment
does exist from their perspectives, how has it contributed (if at all) to creating a
culture that encourages workers to stay at the organization? What do the CEO and
management team perceive they are doing to empower members of the organization
and what do they believe has 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 stakeholder groups of this
provider organization? Is there alignment in their perceptions? To what degree do the
stakeholders view the leadership style of the CEO and management team as
contributors to the organizational culture? How has the culture evolved since the time
when the previous CEO and management team left the provider organization? In
which specific ways has this evolution occurred?
4. What lessons can be learned from this case study and potentially applied to other
aging services providers that are attempting to implement deep culture change for the
purposes of better staff retention?

Research Design
Because the phenomena studied in this research are complex and require context to
understand what is happening, the case study approach was selected. Yin (1994) stated that a
case study is an empirical inquiry that investigates a contemporary phenomenon within its reallife context, especially when the boundaries between phenomenon and context are not clearly
evident (p. 13). The boundaries between leadership, empowerment and culture are blurred even

under the best of circumstances. And yet, theoretical propositions to guide data collection and
analysis do exist. For example, Eaton (2001) concluded that high quality leadership is associated
with environments having lower turnover and better retention of nursing staff, although he does
not specify the leadership style employed in those environments. Taylor (2004) reported that it is
leaders who are responsible for building a climate of retention. Thyer (2003) concluded that
direct care givers respond more favorably to empowerment-based leadership styles. Thyer (2003)
suggested that transactional leadership styles are not conducive to empowerment or a culture of
retention in health services organizations, but studied hospital settings, not aging services
environments. Therefore, although there is some evidence of a connection between certain types
of leadership styles and their efficacy with regard to empowerment and culture change, no
definitive research has been conducted to uncover the type of leadership in specific that leads to
these outcomes in aging services environments.
According to Yin (1994), a research design is an action plan for getting from here to
there (p. 19), and as such, is the method by which research questions are answered so that
conclusions are able to be drawn. The research design addresses how data will be collected,
analyzed and interpreted. It is a logical model of proof that allows the researcher to draw
inferences concerning causal relations among the variables under investigation (Yin, 1994, p.

Rationale for Methodology

Theory development is essential within the realm of case study (Yin, 1994). Theoretical
propositions guide what data to collect and the strategies for analyzing the data. For this reason,
theory development prior to the collection of any case study data is an essential step in doing

case studies, stated Yin (1994, p. 28). In this case, theory on three affective leadership styles
(transformational, servant, and Level 5) is relevant, as were theories on empowerment and
organizational culture. These theories and their proponents have been outlined in Chapter 2 of
this dissertation.
Case study has been used by various researchers to explore phenomena related to
leadership styles, empowerment and culture. For example, Conger (1985, 1992) has utilized case
study methodology to explore the dimensions of charismatic leadership. In his view, a
quantitatively-based survey fails to capture the great richness of leadership phenomena and
instead leaves us with only sets of highly abstracted and generalized descriptors (Conger, 1998,
p. 114).
Utilizing case study approaches, Conger and Kanungo (1988) uncovered five stages in
the process of empowerment. Rousseau (1995) discovered a phenomenon called drift in which
overly-empowered employees believe they have fulfilled their end of the bargain at work to a
greater extent than the employer does, causing workers to become dissatisfied and eventually
leave their organizations. March and Simon (1958) developed a general model of adaptive
motivated behavior suggesting that some empowerment would create a desire for more
empowerment, resulting in dysfunctional organizational behavior. According to Paul, Niehoff,
and Turnley (2000), there are sociological and psychological theories that support empowerment
approaches, but also those theories suggest that empowerment creates dissatisfaction
eventually (p. 483). These authors posit that economic theory may be most relevant, i.e. finding
the appropriate amount of empowerment for the specific organizational setting. Manion (2004)
interviewed 26 nurse managers in her case study analysis of cultures of retention, finding that
structural empowerment practices are key to retention. Case study has been successfully

employed to develop theories about leadership styles, empowerment and organizational culture.
The research study utilized single case design that can be helpful, according to Yin (1994), to
determine whether a theorys propositions are correct or whether some alternative set of
explanations might be more relevant and can represent a significant contribution to knowledge
and theory-building (p. 38).
A second rationale for a single case study, according to Yin (1994) is when the case is
unique. This study examined the unusual case of a recently-hired CEO and management team
from outside the field of aging services brought in to replace what was perceived to be an
authoritative and bureaucratic management style by the board of directors. Traditionally, the
field of aging services has been populated by CEOs and management teams brought up through
the ranks, not from outside the provider organizations. In conclusion, Yin (1994) stated:
Overall, the single case design is eminently justifiable under certain conditionswhere the case
represents a critical test of existing theory, where the case is a rare or unique event, or where the
case serves a revelatory purpose (p. 44).

Sampling Design
The research employed what is known as an embedded case study, involving more than
one unit of analysis. This type of design is selected due to the fact that there are multiple
locations and more than one unit of analysis within the aging services provider organization to be
studied. McClintock (1985) stated that embedded units can be selected through sampling or
cluster techniques. The main unit will be the organization as a whole, the smallest unit will be an
individual member of the organization, and several intermediary units will also be examined. At
each level of analysis, a variety of data collection techniques will be used.

Theoretical sampling, as opposed to statistical sampling, was used. According to Strauss

and Corbin (1998), theoretical sampling cannot be planned before embarking on a study because
the specific sampling decisions evolve during the research process (p. 215). However, the
researcher is able to anticipate that events are likely to take place that will contribute to
knowledge creation. Additionally, by conducting qualitative inquiry through events created by
the research, data is uncovered to support theory creation or extension. Sampling tends to
become more purposeful and focused as the research progresses. Sampling continues until all
categories are saturated; that is, no new or significant data emerge and the categories are well
developed in terms of properties and dimensions (Strauss & Corbin, 1998, p. 215).
For the purposes of this study, judgment sampling was applied, a type of purposive
sampling (Cooper & Schindler, 2003). This sampling procedure involved the selection of sample
members who conformed to certain criteria, those who were initially most appropriate to answer
the specific research questions. The researcher, for example, wanted to explore the perceptions of
various stakeholders who were involved with the aging services provider organization before and
during the tenure of the current CEO and management team to uncover differences observed in
empowerment practices and overall culture changes within the organization. A looselydeveloped quota sampling also was used, as in the case of designing focus groups to uncover
perceptions of specific types of employees. For instance, a focus group of direct care staff
employed at a campus owned by the aging services provider organization where there was an
extremely low turnover rate was conducted to obtain a rich understanding of perceptions among
this category of employees. A separate focus group comprised of nursing directors who
supervised direct care workers was also designed. To ensure that a variety of points of view was
examined, snowball sampling was employed by the researcher. This type of sampling occurred

as data collection proceeded, whereby employees were identified with specific stories and
opinions to share about the phenomena being observed. This sampling technique is particularly
useful in the development of disconfirming evidence, adding to the validity of the research. For
this reason, two site visits were built into the research design.
Initial planned interviews and focus groups include 28 participants, including the CEO
and home office employees (seven interviews), directors of nursing at six campuses (six
individuals participating in a focus group) and direct care staff (seven individuals participating
in a focus group), as well as board members (three interviews) and community
members/residents (five interviews). The researcher audiotaped interviews and focus group
discussions, ensuring that all interviews were kept confidential and anonymous. Only the
researcher and the professional paid transcriptionist had access to the audiotapes. As the
interviews progressed, additional participants were selected for interviews. In addition, the
researcher attended several pre-established meetings as an observer. These meetings included a
board of directors meeting, a departmental-level meeting and an executive level meeting.

Procedures for Consent to Participate, Participants at Risk and Confidentiality

An informed consent document was created and participants were asked to sign the
document prior to the conduct of any research. This document, found in Appendix A, provided a
description of the study, contact information and an outline of how confidentiality will be
maintained throughout the course of the research. The interviews were tape recorded and
transcribed for the purposes of credibility, validity and accuracy. Transcripts will be stored for
seven years in a locked safety deposit box in the home of the researcher and destroyed in 2013.


No reference to individual names will remain on the transcripts to ensure confidentiality of the

Methods and Procedures for Data Collection, Including Researcher Participation

A matrix (see Appendix C) summarizes the amount and types of data collection that were
employed by the researcher to conduct the study described in this dissertation. To increase the
validity of the study, the researcher collected data from multiple levels and functions within the
organization. For example, the direct care staff focus group involved workers employed at a rural
campus owned by the provider organization but located 5 hours away from the corporate
headquarters. Triangulation was employed involving the use of multiple sources of information
as well as multiple methods for gathering the information. In addition to the one-on-one depth
interviews, focus groups and observations, the researcher performed a content analysis of various
documents including previous research studies (employee and resident satisfaction), house
organs, organizational mission and vision statements, minutes from board meetings, annual
reports and newspaper clippings. Confirmation or denial of emergent patterns in the data is
possible when varied sources of information are collected. Interview and focus group guides are
found in Appendix B.
According to Yin (1994), case study data collection procedures are not routine in nature,
and the skills required for case study data collection are more demanding than those required for
experiments and surveys. During data collection, only a more experienced investigator will be
able to take advantage of unexpected opportunities rather than being trapped by them (p. 55).
For this reason, unstructured interviews were used during initial data collection as a way
of encouraging participants to share stories and define certain terms (such as empowerment)

from the perspectives of the interviewees, as opposed to the researchers preconceived

definitions. Conger (1998) recommended the encouragement of spontaneous remarks about
leadership styles, as opposed to asking direct questions such as do you consider your supervisor
to have a transformational leadership style?. The other reason for less structured interview
questions was to mitigate the probability of presentational data. Stated Conger (1998):
The study of leadership is particularly prone to presentational data. If an executive or
his/her subordinates believe they are part of a leadership study, there will be a
conscious and unconscious desire to enhance their image through presentational data.
Qualitative researchers must be particularly cautious in discerning what the fictionalized
images are, actions and behaviors versus the actual, day-to-day operating behavior of the
leader. (p. 111)
Researcher bias was minimally relevant in this study. However, because the researcher
has written an article for a professional journal, Future Age Magazine, which suggests that the
CEO being studied may possess one or more Level 5 leadership traits, it was incumbent on the
researcher to actively seek out disconfirming evidence about this assumption. Another way to
overcome researcher bias was to ensure CEO did not select those to be interviewed. The
researcher, for example, requested a list of all potential interviewees, and discussed the
characteristics of these individuals with a mid-level manager in the home office before a final
selection was made. Such questions as will this person be reticent to tell me what he or she truly
believes? were asked of the manager, and in two cases, those selected to be interviewed were
changed. When the researcher conducted the first site visit, names of other individuals who
emerged as those holding strong points of view were solicited, and these individuals were
interviewed during the second site visit.
The researchers role was to identify the best ways during the course of the on-site visits
to interview, observe and solicit the views of a diverse sampling of employees, managers, board
members, and community members. The researcher collected and examined a wide variety of

documents such as strategic plans, employee and resident satisfaction study results, annual
reports, board of director minutes, back issues of house organs, organizational charts and other
materials that assisted in the discovery of the culture that previously and currently exists at the
provider organization.

Data Analysis Procedures

The intention of the interviews, focus groups and observation of meetings was to uncover
key words that are used to describe the leadership style(s), management techniques and culture
of the provider organization under study. Transcripts were produced, allowing for the
examination and analysis of words were then axial-coded. Axial coding allows the researcher to
systemically develop codes (tags or labels for assigning units of meaning) that are linked with
the phenomena being studied: leadership style, empowerment and culture. Stated Strauss and
Corbin (1998):
As with all phases of analysis, integration is an interaction between the analyst and the
data. Brought into that interaction in the analytic gestalt, which includes not only who the
analyst is but also the evolution of thinking that occurs over time through immersion in
the data and the cumulative body of fields that have been recorded in memos and
diagrams. (p. 144)
Such diagrams include a start list of codes, category cards, and pattern coding (a way
of grouping data into themes or constructs). Glaser (1978) advocated the use of memos, whereby
the researcher writes up ideas about codes and their relationships: it can be a sentence,
paragraph or a few pages (p. 83). The intent of memoing is to tie different pieces of data
together into a cluster. According to Miles and Huberman (1994), memoing helps the analyst
move easily from empirical data to a conceptual level, refining and expanding codes further,
developing key categories and showing their relationships, and building toward a more

integrated understanding of events, processes and interactions in the case (p. 74). It is also a
useful technique in assisting the researcher to identify similarities and differences within the
data. The researcher utilized memoing as a method of recording sequential impressions and
thoughts before, during and after the site visits.
Following this level of analysis, the researcher continued to collect data, identifying
themes and trends in the overall data, and then developed propositions to construct an
explanatory framework that culminated in the integration of data into one explanatory
framework. The recording of interviews, focus groups and observations into transcript form,
coupled with the researchers own memos, were important building blocks supporting the
evolvement and refinement of theory. Miles and Huberman (1994) proposed using an iterative
approach to qualitative data analysis, including the process of data reduction, which involves
choosing the data most useful and transforming that data into manageable chunks. Putting the
data into an organized diagram allowed for the analysis of relationships. Importantly, verbatim
quotes illustrated a deeper understanding of the emergent theory being uncovered through this
iterative process.

Limitations of Methodology
Validity is a major challenge to the qualitative researcher. Validity has to do with being
accurate and correct in conducting the research and reporting the findings. Prolonged
involvement in the study, triangulation (multiple data sources that converge and support one
another), member checking (having participants provide feedback to preliminary findings) and
other techniques were applied to ensure validity in this qualitative study.


There are also strategies for dealing with researcher bias in qualitative studies, including
triangulation, peer debriefing, member checking and negative case analysis (Robson, 2002).
Similarly, qualitative researchers can reduce respondent bias through prolonged involvement,
triangulation, and member checking. All these methods were used by the researcher in this
embedded case study. The negative case analysis occurred when the researcher observed and
interviewed a leader within the organization who does not embrace empowerment-based
leadership theories.
Reliability is a difficult dimension to control for in qualitative research. Qualitative
research by its nature implies some degree of subjectivity. The notion of consistency is at the
essence of reliability, meaning that if a second researcher were to conduct the same study using
the same techniques as the original researcher, the findings would be fundamentally the same.
For example, two observers of an event (such as a board meeting) would produce similar
conclusions regarding what went on at the board meeting.
In addition to the challenges with validity, reliability, researcher bias and respondent bias,
qualitative studies are susceptible to questions about generalizability. This is especially true with
single case studies where the researcher is extremely selective about the people interviewed and
situations observed. This type of bias threatens internal generalizability, which Maxwell (1992)
defines as conclusions within the setting studied.
The researchers familiarity with the field being studied was both an advantage and a
disadvantage to the researcher. For one, the researcher is known in the field to a few in
management due to prior interviews conducted for an article published in a magazine widely
read in the field. However, it was familiarity with the field that allowed the researcher to avoid
being swayed by comments and behavior that were not consistent with the phenomena being

studied and to ask deep, probing questions. Researchers unfamiliar with the field may have been
hesitant to challenge comments made by interviewees or reticent to make follow-up inquiries and
Miles and Huberman (1994) suggested several other techniques for increasing validity
and reliability, while reducing researcher and respondent bias: (a) spending additional time on
site hanging out in a non-researcher mode, (b) using unobtrusive measures where possible, (c)
interviewing participants off-site in a relaxed setting, (d) including lower status informants in
addition to elite status participants, (e) including participants who are dissidents and have
different perspectives from the mainstream, (f) finding an informant who can provide
background and historical information about the organization being studied, (g) triangulating the
data, (h) underplaying the expertise of the researcher in the subject matter, and (i) sharing field
notes with a colleague. All of the aforementioned techniques were employed by the researcher,
with the exception of the last strategy.

Ethical Issues
Ethical issues involved in this proposed study revolved around the confidentiality of the
information collected. Because the researcher had some familiarity with the CEO at the provider
organization through professional circles (although the organization is not a client of the
researcher), it was important to designate how information derived from the study would be
shared with the CEO. The researcher and CEO had a conversation prior to any research being
conducted about the fact that no ones identity would be revealed and that the researcher would
hold in confidence any sensitive information emanating from the interviews. The CEO was asked
to review the research findings section of the dissertation for accuracy only, which she did. The

CEO, herself once a PhD candidate, understood the importance of maintaining the integrity of
the findings.



The purpose of the research conducted was to understand the relationships among
leadership style, empowerment and culture change. The study of these interrelationships is
expected to contribute knowledge about how aging services organizations can promote cultures
of retention, defined as places where employees want to stay (Manion, 2004). Although there
has been a considerable amount of research on the topic of retention strategies, there has been
less exploration of the type of leaders and their specific leadership characteristics that lead to
such a culture. Thyer (2003) has suggested that transformational leadership is the style most
conducive to retention culture change in the healthcare environment, but beyond this, little
evidence has been gathered regarding the particular characteristics contributing to this type of
culture. The organization studied has a markedly higher retention rate than the industry average,
and on two of its campuses, the turnover is reported as being less than 10%. On one campus in
particular, the overall turnover rate is particularly low7.2%; with certified nursing assistant
turnover at 30%, less than half the industry average of 71% (U.S. Department of Health and
Human Services, 2004). This campus leadership was one focus of the qualitative study.
Participants involved in the qualitative research included individuals from all levels
within the organization, a mix of employees at the executive level, the middle management of
the organization, and the front lines (where direct care is provided). This type of investigation is
known as an embedded case study (McClintock, 1985). Using a theoretical sampling strategy,
the researcher identified the CEO and her executive management team, middle managers located

in the home office, directors of nursing at six campuses, campus and field leaders (including the
leader and front line workers at the campus where overall turnover is 7.2%), as well as board
members and residents living or receiving care in one of the organizations assisted living or
skilled nursing units to participate in phase 1 of the study. This group was comprised of 28
individuals, of whom 13 were focus group participants.
For the second phase of the study, a snowball sampling method was used to identify other
individuals for a second round of interviews, which occurred 3 weeks after the initial site visit.
The second group of participants was comprised of 11 additional individuals, contributing to a
total of 39 persons involved in the study. The CEO of the organization was interviewed twice,
once at the beginning of the study and another time at the very end of the study. The scheduling
of a second interview at the end of the data collection process allowed the researcher to ask
questions that were noted during the course of the site visit as important to ask the CEO, but had
not originally occurred to the researcher as important. The profile of participants in the case
study is found below.

Table 1. Participant Profile

Home Office

CEO*, executive staff (7) Middle managers (6)

Internal consultant (1)


Direct care staff (7)

DONS (6)**

Campus directors (4)


Board members (3)

Residents (5)

Note. * Interviewed twice, once at the beginning of the research study and once at the end, ** Directors of Nursing
from six campuses


About the Organization

The organization studied is a leading provider of senior housing, skilled nursing,
rehabilitation, home care and hospice services in the Midwest. The organization was founded in
1862 by the Evangelical Lutheran Church of America. The organization owns 25 senior housing
facilities and manages 30 others. In addition, it owns 11 nursing homes and manages 11 more. A
total of 4,233 residents are served by 4,167 employees employed by the organization. The
organization was selected by the researcher after its designation as a winner of the Great Places
to Work competition sponsored by a regional business journal who surveyed employees about
the quality of their workplaces. The organization has developed a list of leadership competencies
that focuses heavily on relationship development, seen as important to the retention of workers
by prominent healthcare researchers such as Manion (2004) and Thyer (2003). Among the key
leadership competencies identified are: relationship management (the ability to establish
relationships and influence complex networks of others, inside and out of the organization);
communication skills (effectively communicates to others using appropriate vehicles and forums
to advance business, team and organizational goals); resiliency (the capacity to successfully
respond and adapt to adversity and change) and integrity/trust (displays high standards of
judgment and character). These competencies serve as a guide to leaders throughout the
organization and set forward managements expectations.

Interviews and Focus Groups

The researcher utilized open ended questions in both the one-on-one interviews and the
two focus group sessions. Topics related to the perceived culture of the organization before and
after the hiring of its CEO, now in her third year in that position, were probed. Participants were

also asked to share perceptions and information regarding staff empowerment, the leadership
styles of the CEO/management team, campus directors and supervisors, as well as other
questions to better understand the organizational culture, retention and how leaders contribute to
both. Questions typically followed the order in which they are listed (Appendix B); however, the
researcher was flexible with follow-up questions and probing more deeply into specific
comments made by the participants. The researcher was careful to check with participants to see
if dissenting viewpoints were held. This technique of searching for disconfirming evidence was
helpful in identifying pattern variations (Strauss & Corbin, 1998, p. 67).
Participants were enthusiastic about sharing their perceptions about the organization. The
researcher noted a universal optimism and sense of adventure demonstrated by the participants.
There was general excitement about the culture being created, and the researcher observed that
these participants were eager to talk about changes that had occurred within the organization.
Many of the participants, including the leader of the campus with a particularly low
turnover rate, served the organization prior to the arrival of the CEO in 2003, and continue to be
employed there. Perceptions of these participants were noted by the researcher in an attempt to
fully understand differences in the two CEO leadership styles and how they impacted the
organization with regard to its culture change.
The researcher took field notes, utilized memoing to record impressions and body
language, and audiotaped each interview and focus group. These audiotapes were transcribed so
that microanalysis of the data could be carried out (Strauss & Corbin, 1998, p. 58). In addition,
the researcher spent a considerable amount of time in less structured settings and situations, as a
casual observer of the organizations culture. For example, the researcher observed a day-long
board of directors meeting, participated in the home offices summer picnic, and wandered the

hallways of several campuses, observing direct care staff as they interacted with residents. The
researcher spent 6 hours traveling to two distant campuses with the CEO and her Director of
Special Projects. Observations from these experiences were recorded by the researcher in memo

How Data Were Coded

Transcripts of the audiotaped interviews and focus groups were provided by an
independent transcriptionist based in Pennsylvania. Upon completion of the transcribed
interviews and focus groups, each document was read and re-read 10 to 12 times as part of a
microanalysis strategy. A total of 667 single-spaced pages of transcribed interviews were
reviewed in this fashion. Strauss and Corbin (1998) described the microanalysis process as: The
detailed line-by-line analysis necessary at the beginning of a study to generate initial categories
(with their properties and dimensions) and to suggest relationships among categories; a
combination of open and axial coding. (p. 57).
According to Strauss and Corbin (1997), this type of analysis involves very careful,
often minute examination and interpretation of data (p. 58). It is important to note that
microanalysis takes into consideration not only the data themselves and the actors interpretation
of events, but also the interplay between data and the researcher (Strauss & Corbin, 1998, p. 58).
According to the authors, this type of analysis involves a radically different way of thinking
about data (p. 59) and relies on identification of connections among issues and themes by the
researcher. Microscopic analysis requires the researcher to pay attention to detail in both a
descriptive and analytic sense, preventing the researcher from jumping precipitously to our own
theoretical conclusions (p. 65). Theoretical comparisons, according to these authors, are an

essential component of theory building, and are aligned with the strategy of microscopic
analysis. The making of theoretical comparisons has another function, wrote Strauss and
Corbin (1998), allowing the researcher to consider the phenomenon observed in a more abstract
way, moving from the specific to the universal and labeling concepts in a provisional manner
(p. 83).
The first steps in microanalysis are the identification of words that point to meaningful
phenomena and the construction of a list of all the possible meanings of the word that come to
mind (Strauss & Corbin, 1998, p. 93). The researcher developed a preliminary list of words and
phrases that repeatedly emerged in the data as being associated with the type of leadership that
inspires culture change and retention within the aging services environment being studied. These
words originated from the stories conveyed by those interviewed. For example, when
interviewees were asked to describe the leadership styles of the CEO and their direct supervisors,
there was a deep thread of continuity throughout all layers of the organization as evidenced by
the following quotes:
Mid-Level Manager: My current supervisor is direct and honest. She communicates what
her expectations are. When I met the CEO, same thing. I felt like there was a safe place
for me to go and discuss issues. She was open and you know, she was transparent in what
she was doing. Shes approachable Ive never been scared or nervous or anything like
that to go in and talk to her about anything. I can be authentic be who I am because
she is authentic.
Executive in Home Office: The current CEO there is huge sincerity there. What you
see is what you get. She is really open to new ideas and getting our feedback.
Direct Care Worker at Campus Level: Our administrator is our role model. She lets her
true colors show. She doesnt pretend to have all the answers and invites us to put in our
two cents all the time.
Field Manager: My observation about leaders here they invite others into the
conversation. If they dont have the answer, they say so. Everyone is pretty much an open
book with nothing to hide. You just dont have the egos, or the need to hold information

close to the vest. Everything is out in the open and we try to help each other. It comes
from the top down.
Certified Nursing Assistant: We are like family here we watch each others back.
There is a high degree of trust between us. And we just take care of one another. And
when we mess up, we can be honest about it. Its not like we cover anything up with one
Director of Nursing: My administrator doesnt really know that much about nursing, but
that is OK with both of us. He depends on me to know about that, and there is no pretense
there. This is the type of authenticity that contributes to our working relationship its
all above board and out there. I tell him what I need, he gets it for me. He follows through
and keeps his promises to me. This makes for an excellent partnership between us. He
knows a ton about finance; I know very little. Hes good at what he does and Im good at
what I do.
These quotes illustrate a marked change in the culture of the organization, compared to
its history as an organization once known for secrecy and untrusting relationships where
paranoia was evident. A Middle Manager described the previous culture this way:
The culture used to be one of secrecy. For instance, when I first started here my
responsibility was to recruit for the home office. I asked my (former) boss What is my
budget for recruitment? and she responded Well tell you when to stop. That was her
response, which was completely foreign to me. So I was wondering what my budget
constraints were, and there was no published budget. I perceived very much of a its
none of your business attitude. Nobody would ever give me anything to understand the
organizational structure, and I am in human resources! People back then would just poopoo my desire to figure things out and they would laugh at me and say things like it will
take you a year to learn that, and I am wondering whats the big secret? Why cant you
tell me? Why cant you come up with an organizational chart to help me understand so I
can do my job better? It seemed to me like you had to have an executive title or you
needed to belong to a certain set of employees in order to get that information.
Another Mid-level Manager described his experience as a consultant with the former
organizations leadership, and how it contrasts with the current organization (by which he is now
What struck me was the sense of wanting to keep things under wrap and not be
transparent, not discussing things openly, keeping things from the public. I felt like it was
a culture of silos, and things being told only on a need to know basis. It was a real
uneasy feeling a lot of anxiety going on you could just feel it throughout the
organization back then. Today, it is a whole new ballgame.

Many stories were told to the researcher about the atmosphere of the old organization
and how it differed from the current organizational culture. A board member recalls this
A good example is that there were things going on before that I was not aware of. There
were things going on in the pension board health insurance program that I was not aware
of until now were going back and digging and were finding out all of these things.
Our former CFO was involved with the IRS. Now we have a new CFO who used to be
with Multi-Foods if I am not mistaken. Now theres a big difference in the way things are
operating...much more out in the open.
It became evident through the course of conducting the interviews that themes were
emerging around the concepts of transparency, trust and empowerment. Words, phrases, and
observations that were mentioned by participants and noted by the interviewer included: open
door, open book, nothing to hide, above board, doesnt know it all, lets true colors show, what
you see is what you get, authenticity, open to ideas and suggestions, desires feedback from
subordinates, invites participation, keeps promises, follows through, demonstrates consistent
behavior, benevolence, skilled and competent, freedom, flexibility, no second guessing, no
looking over our shoulder, no finger-pointing, encourages experimentation and innovation, and
learning from mistakes. Many of these comments were recorded during a focus group session
with direct care workers located at the campus where there is an overall turnover of 7.2%. This
campus became a particular focus of the study because the leader of the organization was
mentioned repeatedly by others as an outstanding example of leadership that inspires culture
change, and in particular, a culture of retention. This campus leader has served the organization a
total of 12 years, three of which under the current CEO. She had this to share:
Since accepting employment (at name of organization), I have not considered a new job. I
have the perfect job with the opportunity to continually learn, grow, advance and be a
change agent. I can help others become the best they can be.

One of the major accomplishments cited by this leader is a decrease in staff turnover
from over 100% to 7.2%. Table 2 shows turnover rates at this campus by type of position.

Table 2. 2006 Nursing Home Turnover Statistics


Open Coding of the Data

Open coding is the analytic process through which concepts are identified and their
properties and dimensions are discovered in data (Strauss & Corbin, 1998, p. 101). The
researcher coded words and phrases used by front-line employees from the low-turnover campus
involved in a focus group, as well as other words used to describe the overall culture of the
organization by a wide variety of stakeholders. It was discovered that many of the same words
and phrases used to describe the atmosphere and leadership characteristics present at the campus
level were also used to describe the atmosphere and leadership characteristics of the organization
as a whole. After identification of the range of meanings contained within words utilized by
participants or observations made by the researcher, labels were developed for three major
concepts: transparency, trustworthiness and empowerment. Upon review of the transcripts, it was
also discovered by the researcher that three more key concepts emerged from the data:
connectivity, accountability and optimism. The researcher conducted a line-by-line analysis of
the data, commonly known as microanalysis, to develop the six primary leadership behavior
concepts. Microanalysis involves the conceptualization of groups of similar items according to
defined properties and the assignment of a name that provides what Strauss and Corbin call that
common link (p. 121).
Axial coding is a term to describe coding that occurs around the axis of a category (p.
123). In essence, this type of coding is a way of looking at conceptual linkages among
categories. When analysts code axially, they look for answers to questions such as why or how
come, where, when, how and with what results, and in so doing they uncover relationships
among categories (p. 127). These answers take the form of themes, which Leininger (1985)


posited brings together components or fragments of ideas or experiences, which often are
meaningless when viewed alone (p. 60).
Table 3 consists of six major concepts and the words that inspired their labels.

Table 3. Leadership Characteristics Inspiring Culture Change

Transparency: open door, open book, nothing to hide, above board, doesnt know it all; lets true
colors show, what you see is what you get, authentic, open to ideas and suggestions, desires
feedback from subordinates, invites participation
Trustworthiness: keeps promises, follows through, demonstrates consistent behavior, honest,
benevolent, skilled and competent
Connectivity: utilizes skills of others, invites feedback and collaboration, leverages social capital,
forms alliances, internal and external communications, image building and branding, utilization
of technology to form networks, socialization and recognition of individuals in the organization,
helping fellow employees
Accountability: tracks meaningful metrics, holds high expectations of others, accepts
responsibility for own actions, performance measures and dashboard results
Empowerment: freedom, flexibility, invites participation and creative idea-sharing, no second
guessing, no looking over shoulder, no finger-pointing, encourages experimentation, learning
from mistakes, innovation
Optimism: forward-looking, positive, inspirational, gives the benefit of the doubt, sees setbacks
as temporary, expects the best, confidence that things will work out the way they should

Aronson (1994) believes that once coding has occurred, reading the related literature is
important. He stated: By referring back to the literature, the interviewer gains information that
allows him or herself to make inferences from the interview. Once the themes have been
collected and the literature has been studied, the researcher is ready to formulate theme
statements to develop a story line (p. 2).


The integration of theory with data is another technique utilized by the researcher to code
information. Table 4 summarizes the theoretical underpinnings associated with each leadership
characteristic identified as inspiring culture change and retention. Prominent theorists who have
studied the identified concepts are noted, along with the salient findings of their work.

Table 4. Theoretical Underpinnings Associated With Identified Leadership Characteristics



Pagano (2004)


Asks opinions




Skilled mistake-handling

Respectful language with subordinates

Mishra (1996)



Concern for others


Mayer, Davis, & Schoorman (1995)




Sitkin & Roth (1993)

Value congruence


Table 4. Theoretical Underpinnings Associated With Identified Leadership Characteristics


Prusak & Cohen (2001)

Networks provide incubators of collaboration

Nahapiet & Ghoshal (1998)

Relationship fulfills needs of approval/socialization, recognition and


King (2003)


Organizational legitimacy is result of connections made

Connors & Smith (1999)

Shift beliefs first

Provide constructive feedback to reinforce accountability

Internal alignment/no silos

Samuel & Novak (2000)

Information sharing

Break down silos

Recognition of those who are accountable


Kanter (1993)
Structural empowerment

Access to information

Provide opportunities to learn

Spreitzer (1995)
Psychological empowerment

Provide job meaning



Job impact

Seligman (2006)

Strong locus of control

External personalization: Good events seen as permanent; bad events seen

as temporary

The intent of blending the open codes with theory from the literature is to look at data in
new and novel ways, and to build up a dense texture of relationships around the axis of the
category being focused upon (Strauss, 1987, p. 64). By sorting and re-sorting the six originally
identified concepts, the researcher is attempting to find emergent patterns and themes in the data.
Patterns and themes are the gestalts that pull together connections within the data and its multiple
categories, according to Miles and Huberman (1994). However, a potential liability in noting
patterns is a tendency to see themes where none really exist. The researcher needs to remain
open to disconfirming evidence, noted on the next page.

Table 5. Disconfirming Evidence Noted Within Organizational Culture

Transparency: When asked if there were any areas not transparent enough within the
organization, two individuals questioned whether financials were shared with the field. The
researcher queried the CEO about this. Her response: Were probably not as good at that as we
should be.
Trustworthiness: One middle level subordinate noted that her direct supervisor did not always
acknowledge her when she arrived at work each morning, which made the subordinate wonder
where she stood with her supervisor; whether the supervisor was snubbing her for some reason.
A resident interviewed noted that she perceived it was just talk when someone from the
corporate office said she would get back to the residents about potentially funding a chapel at
their assisted living campus.
Connectivity: The organization was unable to suggest outside community members other than
board members to interview during the data collection phase of the research. One senior
executive noted in an interview that board attendance was not as strong as it could be.
Accountability: The organization currently does not have a uniform method of tracking
employee turnover corporately; each campus tracks turnover differently.
Empowerment: No disconfirming evidence noted or observed.
Optimism: One DON questioned the organizations ability to transition from a nursing home
model to a continuum of care model. Her question was who will have the money to pay for
these services (since they will likely not be covered by Medicaid or Medicare)?


Leadership Characteristic 1: Transparency

Transparency as defined by Webster is the state of being easily understood, candid, frank
and open. It is the quality of being translucent; so sheer as to permit light to pass through. Data
collected during two on-site visits, coupled with observations and memos, point to transparency
on the part of many leaders, and structurally throughout the organization. In contrast, the culture
of the previous organization was described by those interviewed as secretive and mysterious.
Participants used a variety of phrases to describe transparency within the organization: open door
policies, open book management, nothing to hide, above board, leaders who dont know it all,
lets true colors show, what you see is what you get, authenticity, openness to ideas and
suggestions, desiring feedback from subordinates, and inviting participation at all levels.
Kerfoot (2004) stated that its probably fair to say that the concept of concealment is
alive and well in healthcare (p. 33). She advocates a concept known as open enterprise,
describing organizations that are actively transparent, even when the news is bad. During the
course of the researchers site visit, one of the long-term care facilities managed by the
organization was named to the Consumer Reports list of worst nursing homes in the state.
Although it was later discovered that the formula used by this publication may have been flawed,
the initial response by the organizations leadership was enlightening. Across the board, the
management team was forthcoming about the report, telling the researcher immediately about the
poor ranking and having a completely non-defensive stance about the revelation. The facility in
question was visited by the researcher the day after the report was published, and there was no
attempt by the administrator there to cover up or make excuses for the report findings, except
to note that surveyors in the state were more rigorous than those in other states and cited
deficiencies much more frequently (this is a well-known fact nationally among those familiar

with the long-term care field). One senior manager was overheard at a home office picnic
reflecting on the report, stating I wonder how we can look at this and turn it into an opportunity
for change and improvement? How can we leverage this negative into a positive for a better
future for our seniors?
The difference between the old culture, steeped in opacity, and the new culture, whose
foundation is transparency, was evident to the 11 individuals interviewed who had experienced
both organizations. Honesty, asking opinions, authenticity, promise keeping, mistake handling
all these behaviors are rooted in the notion of transparency as articulated by Pagano (2004).
A Middle Manager who has been employed by the organization for 6 years (3 years
under the old culture; 3 years under the new culture) summarized the transition to a transparent
culture in this way:
As it relates to the current CEO, she made it very clear from the get-go that we werent
going to continue to live dysfunctionally (as we did under the former administration). She
made it clear that we were going to act as professional colleagues and treat each with
respect (something that was lacking in the former organization). She told us the old days
were behind us and that we were going to move forward. I think that her setting the tone
of openness and honesty, and the board of trustees setting that tone, made it very clear to
us as an organization that this was a new day. The board hired someone to come in and
redefine us as an organization, to help us reshape the future of older adult services, and
do it in a forthcoming way. And our culture has indeed been transformed throughout the
A Direct Care Worker at the campus where turnover is low described the leader of that
campus in this way:
Our administrator is an excellent role model for us she invites our ideas and she listens
to what we have to say. Back when our turnover was high she told us she needed our help
to find a solution, and we worked together as a team to find the answer. There was never
an attitude that she had the answer herself. She was very open with us in saying she
wanted our input on how to solve this problem. Our turnover rate was so high at one time
it was just terrible and she looked at us and said what are we doing wrong? What can we
do to make it better? I want your feedback. She didnt pretend like she had the answer,
she wanted our involvement. She is a very approachable person.

Leadership Characteristic 2: Trustworthiness

Creed and Miles (1996) posited that managerial philosophies shape trust levels within
organizations, and that these philosophies flow from basic assumptions about organizational
members (p. 21). In the case of the organization being studied, trust at the home office has been
facilitated in part by the CEO bringing on board her own trusted colleagues with whom she has
worked in other environments. Because she trusts these individuals and her own trustworthiness
is high, others who once served under the old culture more automatically trust the new
executives she has brought into the organization over the past 3 years.
A Middle Manager who was employed under the former leadership in the home office
described the trust engendered by the current CEO in this way:
Shes [current CEO] a quiet giant in my opinion. I mean she is a very, very effective
leader, but she does not rule with this iron fist, you know. She is very strong. She has
surrounded herself with incredibly talented people. And she believes in empowering
people to do their job. And she is, you know I think that the relationships she has here
at the home office and out in the field are based on trust and mutual respect. And I think
that has played a huge part in people really wanting to work hard for her in the
organization. I mean, you know, people respect where the CEO is taking us. They
recognize her presence here adds value to the organization. They believe in her
There is a parallel in the trust inspired by the CEO and the trust inspired by the campus
leader where low turnover is present. One subordinate stated:
We really are like a family here. When someone new is hired they are really part of our
family right from the get-go. Our administrator encourages this. The trust thing is a really
big deal here. We trust her, she is our mentor, and I think it just kind of flows through.
Hardy, Phillips, and Lawrence (2002) believe that cooperation is achieved through the
use of symbolic power to create shared meanings where none existed before (p. 81). Shared
meaning in turn brings about innovative outcomes that benefit all members of the relationship.
Trust must therefore be signaled, and one manifestation of trust is the ability to manage conflict

productively. The researcher observed a strategic planning meeting where this type of conflict
existed, was acknowledged and was not swept under the table. The senior management team had
been engaged for months prior in an ongoing debate about the organizations decision to sell off
a non-profitable nursing home and to build a continuing care retirement community in the future.
The CEO actively encouraged this debate and solicited opinions from all her direct reports,
asking What do you really think about this? Is this a good idea from your perspective? The
CEO skillfully guided the conversation over the course of several executive sessions and
demonstrated an openness to changing her own opinion if others made persuasive arguments for
their case. In the end, a consensus was reached to sell off the non-profitable nursing home.
In addition to effective conflict management, another trust-building component is the
display of benevolence, or concern for the well-being of another. An example of benevolence
was evidenced when the researcher was talking on the phone with the CEO prior to the first site
visit to coordinate logistics of the visit. The CEO mentioned that the director of HR was out on
sick leave due to an eye surgery. Compassion filled the CEOs voice with concern for her
employee. On another occasion, during a 6-hour car ride to another site, the researcher was
struck by the CEOs benevolence toward a pregnant co-worker who was also riding in the car.
This care for the other was demonstrated by many other leaders in the organization who were
observed and interviewed by the researcher. Benevolence, or concern for others, is a key
component of both the Mishra (1996) and Mayer, Davis, and Schoorman (1995) trust models.
The CEO, in describing her own style and that of her top management team, stated:
We try to be ethical role models. We try to be consistent. We try to honor all
disagreement among ourselves and leave the room and act in accord. We try to hold
ourselves accountable. We try to do what we say we are going to do. We have a set of
team values that we try to follow.

Benevolence, which spawns trust and a sense of being a team, was noted not only at the
top of the organization, but also at the middle of it. Front line workers were asked about the
presence of trust on the low turnover campus during a focus group. These comments are
representative of what the group shared:
We are a close-knit groupwe watch each others back.
I never have anxiety about coming to work on Monday because of the family-oriented
environment and that youre part of the family. We communicate openly with each other.
Managers are out on the floor when we have to work short. There is trust and teamwork
here. A Director of Nursing on another campus spoke of her direct supervisor in this manner:
My boss is ethical and trustworthy. I can say anything to him and he knows exactly what
he needs to keep to himself and what he can talk about, and thats really important to me.
On the other hand, he is very open with staffhe puts the financial statement up on an
overhead and reviews it with us so that we understand what is going on. And I think
thats really cool. He trusts me to do what I need to do too.
These quotes underscore the key components of the Mishra (1996) trust model: openness,
concern for others, and reliability.

Leadership Characteristic 3: Connectivity

The third prominent leadership characteristic derived from the data is connectivity. This
characteristic refers to a wide range of behaviors within and without the organization. It includes
such properties as utilizing the skills of others to the maximum, inviting feedback and
collaboration with others, the leveraging of social capital and the formation of alliances. It also
relates to communication both within and outside the organization, image building and branding,
utilization of technology to form networks and the socialization and identity of individuals.
One prime example of connectivity identified by the researcher is the Innovation Station,
a Web-based application that encourages direct care staff and other employees throughout the

organization to submit innovative ideas that will make the operations of the organization run
more efficiently, or more profitably. This idea was the brainchild of the Small Minds Innovation
Group, which meets regularly to explore new concepts that will benefit the organization. Small
Minds takes its name from the fact that great ideas can often emanate from those who are at the
lower levels of an organizational hierarchy.
The Innovation Station was developed to encourage front line workers to be involved in
culture change at the organization. Innovations are submitted and then evaluated by others within
the organization anonymously. Explains a Middle Manager who is charged with facilitating the
Innovation Station:
We dont care how the ideas come in. It can be anybody, you know, and thats the idea.
We think that all employees have innovative minds in any post in our organization and
that it doesnt matter what your role is. You might be an innovator from maintenance,
changing the way maintenance is done. We hear from CNAs [certified nursing assistants]
and how they are putting together a program to teach leadership qualities. Across the
organization we have all kinds of different people that are sending messages that will lead
to that small minds mentality. In 2005 we had 90 different innovations submittedsome
minor, some major. And anybody who shares an innovation gets an acorn at our annual
leadership conference. These acorns are small and are given often for small innovative
ideas or concepts. Once you get 10 of them you get a large acorn and an innovator
ribbon. We gave 300 little acorns recently at our Leadership Conference everyone gets
recognized, and we give an innovator of the year award. It is really exciting for our
employees, they get very jazzed up by it its more about recognition in front of their
peers. If they want to duplicate their innovation they can get a Majestic Oak, and then
onto the Fertile Ground award. Its how we encourage a culture of innovation at the
organization and recognize those who participate in a positive way. This year we had
more people who got awards than those who didnt. You could tell that the ones who
didnt bother to submit an innovation were kind of kicking themselves they felt a little
out of place at the conference, it seemed to me.
In this way, the organization not only encourages innovation, but creates what Prusak and
Cohen (2001) call incubators of collaboration, a network where people in geographically
dispersed locations have a chance to connect and exchange ideas, and respond to one anothers
creativity. The Leadership Conference, and the bestowing of the acorns on individual employees,

fulfills employee needs of approval, recognition and identity (Nahapiet & Ghoshal, 1998). Other
techniques of connectivity include personal visits from the CEO, dinners held in honor of
employees, and regular newsletter messages from the home office as well at the campus level.
Connectivity also describes the ability of leaders to connect the dots between individual
worker roles and the vision of the organization. This type of connectivity is exemplified by the
fact that all direct care staff and directors of nursing interviewed for this research project
understood the organizations vision clearly, could articulate it and were for the most part,
bought into it, even though the organization historically saw itself solely as a provider of skilled
nursing services. Today the organizations advertising tagline Living fully after 50 has come to
mean much more than nursing care alone.
Another example of connectivity is the video conferencing infrastructure that allows
directors of nursing, campus executives and a wide range of employees to connect with one
another via satellite to discuss problems and develop solutions together, despite a geographic
distance of up to hundreds of miles among the organizations 37 sites, including the home
office. This initiative represents structural empowerment (Spreitzer, 1995).
In an effort to support one another, 400 employees donated more than $75,000 in 2005 to
help fellow workers facing emergency needs or to support those seeking to further their
educational goals. This initiative is called the Family Helping Family program, and it represents
another aspect of connectivity.
An example of connectivity at the low-turnover campus is the creation of a group known
as the Neighborhood Council, comprised of staff and residents who hold social events and
sponsor clubs throughout the year. In this way, the employees and those they serve stay
connected to each other in a deeper way.

Externally, connectivity takes several forms, including editorials written for the local
newspaper that communicate the organizations commitment to culture change and providing
choice to area seniors. Employees have also voted the organization one of the Best Places to
Work in their region 2 years in a row, a distinction that designates the organization as an area
employer of choice. No other regional aging services organization has ever received such a
designation. These efforts, as well as an active public relations and branding campaign, are
designed to create organizational legitimacy (King, 2003), which not only contributes to brand
identity, but also to organizational fundraising efforts, which are critical to the organizations
future success and ability to expand its vision.

Leadership Characteristic 4: Accountability

Samuel and Novak (2000) speak to the need for an accountable culture, involving the
development of new patterns and new habits of behavior. For the organization being studied,
accountability is articulated through a tool simply called The Dashboard, which measures the
critical components of the organizational mission of creating home for older adults wherever
they choose to live. The dashboard, mentioned consistently by senior and middle managers
participating in the study, measures whether residents and families see the organizations
campuses as home (87% do), whether the organization is responsive to choice (88% believe it
is) and whether organizational stakeholders would recommend the organizations to others (92%
would). The dashboard also measures the number of innovations submitted to the Innovation
Station annually (90 in 2005 versus a goal of 39), the solvency of the organization, the payer
mix, and the number of customers served each year. Importantly, the dashboard also measures
employee engagement, as defined by whether the organization creates a sense of home for

residents, offers choices, would recommend the organization as a good place to work, and
whether the employees like their job (4.35 on a scale of 15) (Ecumen, 2006).
Numerous comments regarding accountability were made by study participants. Here is a
sample of some of those comments:
Middle Manager in Home Office: What I think about is levels of accountability. When I
first arrived, the financial systems here were poorly organized and very fragmented so
you had some data over here to track these houses, and data over here for these nursing
homes, but none of the data spoke to each other. Or how many meals on wheels have we
served in the last year? Not a clue. So it made people crazy to try and say where are we
today and how we build a plan to be better when we had no baseline. Theres a much
more planful environment today; we completely revamped the whole way we do
Campus Administrator: The accountability piece is important. Our leaders here
emphasize it. Results are important. In the first 18 months I was here, we really started to
require some accountability of these leaders; we probably let go, oh, three or four of them
maybe. A few of them were asked to leave. I suspect many more left because they didnt
like the accountability. They were loyal to the old team and couldnt stand the heat. We
were happy to see them go. You know, were about getting the right people on the bus.
Director of Nursing: The dashboard has been an incredible tool for us as an organization,
and quite honestly, when I first saw it, Im likeoh, okay, thats pretty weird. But it was
because it was such an ambiguous thing that I could not get my arms wrapped around it
until we started really putting measurements around it and definitions around it. I was
also worried about how wed get a dietary or home health aide to understand it if I was
having a hard time myself. But I think that weve done a very, very good job of defining
our strategic vision, defining the dashboard and passing it down from the CEO to the
regional directors to the campus administrators, from the administrators to their
department heads and throughout each department. I mean, transferring the information
and its importanceweve done a very good job of that. When I am out in the field
talking about the dashboard, it is obvious that people get it. They say things likeyeah
man, weve moved the dial X amount this year.
The dashboard was mentioned by everyone interviewed by the researcher with the
exception of the five residents interviewed for the study. One reason for its prominence in
employees and managers minds is the high visibility it receives in the internal house organ
distributed to all of the organizations 4000 plus employees. For example, the November 2005
issue featured an article headlined Employee engagement fundamental to dashboard and being a

great place to work. The CEO also references it prominently in meetings, organization-wide
speeches, and correspondence to campus leaders.


Figure 2. The dashboard.


Leadership Characteristic 5: Empowerment

Kanter (1993) discusses structural empowerment, which is access to information and
opportunities to learn. Empowerment as defined by the organizations employees included the
following descriptors:
Middle Manager in Home Office: I would describe it as moving obstacles and letting a
person or a team, have responsibility to get the end result. Weve got people working on
projects and theyre empowered to recommend and make changes and so I think its
starting to happen, although I think it probably varies by campus, where you have some
campuses where it goes all the way down. On successful campuses, Ive just got to
believe that is happening.
Campus Administrator: At the campus level, I am pretty much being allowed to do what I
want to do and do my own thing. It is not like somebodys telling me what to do or how
to do it.
Certified Nursing Assistant: I would describe my boss as being very supportive and
letting me do what I do and try not to micromanage me or be on my case about whats
going on.
Director of Nursing #1: He [my supervisor] is very supportive of me. He does not
micromanage. Sometimes I think administrators dont always have a good understanding
of what their nursing department does, but I get the things I ask for. When it comes to a
situation where I have gotten in hot water or something hasnt gone right, hes been very
supportive of that.
Director of Nursing #2: My supervisor lets me to do the things I need to do. When she
gives a task over to me, she trusts me to get it done. She doesnt look over my shoulder.
Its done, its taken care of as far as she is concerned.
Executive in Home Office: She [my supervisor] supports me, she allows me to do my
Spreitzer (1995) posited that psychological empowerment follows structural
empowerment; in other words, once the systems are in place to support empowerment,
psychological empowerment in the form of increased autonomy, decreased job stress, lower
burnout and increased satisfaction/commitment result. The most recent employee satisfaction
survey at the organization, conducted by MyInnerview, a professional satisfaction survey

provider, shows that overall satisfaction of the organizations employees is seven points higher
than the database of all other skilled nursing facilities and four points higher than the database of
all assisted living facility employees.
Psychological empowerment includes four key components:
1. Meaning: Congruence between job requirements and beliefs
2. Competence: Confidence in abilities
3. Self-determination: Feelings of control over ones work/autonomy
4. Impact: Sense of being able to influence important outcomes within the organization
Staff survey results are mixed in terms of correlations between components of
psychological empowerment and factors evaluated on the survey. For example, skilled nursing
employees rated sense of accomplishment four points above the MyInnerview database average;
whereas assisted living employees matched the database average. This measure is not a perfect
approximation of psychological empowerment, but sense of accomplishment is aligned with one
of the four components, that is, impact.

Leadership Characteristic 6: Optimism

Optimism is characterized as a tendency to expect the most favorable outcome of events
or conditions. Seligman (1990) posited that optimism rests on three fulcrums: the explanatory
style one uses to explain good or bad events in life according to permanence (how early one
gives up on something), pervasiveness (how universal or specific a person gets in explaining
events) and personalization (how much people blame themselves for bad events or outcomes).


In interviewing the CEO of the organization, there are several clues pointing to an
optimistic style. The first is a story she tells about her own leadership when she was employed as
head of a state department:
My boss pulled together a group of about 10 people from across the major agencies that
had responsibility for state government and told us we needed to find a way to deal with
the fact that 15 unions were out on strike statewide. He put us in a conference roomall
10 of us were really high-functioning people, and we were all about the same agebut he
doesnt specify who is in charge. I picked up the leadership role and people let me do it,
because it was 24/7 and we were so focused on the same outcome. We just hummed and
were really successful. There werent any horrible outcomes, and I knew there wouldnt
be. It was the first time I had really been given permission to lead, and while I wasnt
given formal authority, it was clear to me that I should take it, and I did. It made a really
huge difference in my career. My mettle was really tested and I think it made a
difference. I knew it could be done and the team worked together to accomplish our goal.
A second story told by the CEO is about a challenge she encountered when named as first
woman to head a major zoo in the United States:
The zoo was built around Beluga whales, and there were two of them. When the zoo
started, these images of the whales were on every billboardthey were the icon for the
zoo. I was there about 3 weeks and the veterinarian came to report that one of the whales
is sick and he needs to do surgery on the whales jaw. I dont know a Beluga whale from
a wombat, and Im thinking to myself, how do would you do surgery on an animal that
needs to be in the water at all times? This is unclear to me. But I know we dont want the
whale to diewhat do I do if that happens, bring in a crane to lift the dead body of a
Kaluga out of the tank? So I call SeaWorld, and they come in to help with the whale
situation. I have reporters calling me at 2 in the morning it got so bad I had to change
my phone number. But I carried on I knew it wouldnt last forever. So we take the
whales out of our state and transport them to San Diego. People were furious I had as
close to death threats as you could get for taking the whales out of the statethere was a
huge to do about this. In fact, the day before the whales left we decided we better do a
free day at the zoo and let people come to say goodbye to them. People were crying at the
tank and it was all done publicly, thank God, because about 3 months later, one of them
dies, not the one who was originally sick, but the other one. Drops to the bottom of the
tank at Sea World, where the staffs expertise is care of marine mammals. But it all
turned out OK, because I did the right thing. I knew I had handled it the best I could
tried my best to keep those whales welland I felt optimistic that it would turn out fine
and it did. It was a watershed experience for me around leadership. When you have that
kind of public pressure, you have to have faith that youll get through it OK and I did.


The third is her admission that she has no idea where the vision will ultimately take the
Heres the biggest challenge for me. I want to change, change, change, change, run as fast
as I can from an outdated model, but I dont know where Im going. I dont know what
the new model is. It appears that nobody knows what the new model is which doesnt
make me uneasy at all. But it does make other people really uneasy. So the challenge for
me is being able to keep people up enough to be able to jump off into the darkness. So
weve positioned ourselves as this transformational organization and have redefined
services for older adults. Transformation of services for older adults I dont know
today exactly what that means. I know its not the Greenhouse [model]; I know its not
that stuff [Wellspring, Eden Alternative and other popular culture change models in the
field]. Its not where Im going. It needs to be a product that I personally want to buy. I
dont want any of those (other models). For Gods sake, dont institutionalize me. Im not
going to be one who signs up for Sun City [an active adult community for age 55 plus
seniors]. Now in the end, what will that whole range of offering look like? I dont know
because I dont know.
The CEO sees this state of unknowing as a temporary situation, not a permanent one.
She expresses confidence that the answer will be found, by her and her team. The tenacity to
never give up, despite all odds, is a cornerstone of optimism, and one can tell by the tone of the
CEOs voice and the passion with which she speaks that she will not stop until she has the new
model for aging services figured out. However, she believes that discovery of the new model
does not rest on her shoulders alone. She is optimistic that her team can and will contribute to
finding the answer with her.
Similarly, the administrator at the low turnover campus is also described as having a
positive attitude by her subordinates who participated in the focus group:
She is very upbeat and has a strong, optimistic view of the future.
I would describe her as always looking for the best in others; she focuses on the positive.
She is a hopeful person and believes in other people. She believes that the best outcome
will occur.


Luthans and Avolio (2003) stated that optimism would seem to be an important
ingredient in the development of authentic leaders. Like hope, there is hardly an inspirational
leader throughout history who made a positive difference in his or her organization who has
not been labeled optimistic (p. 255).

Discovery of Six Connector Concepts

The data revealed six major concepts derived from the transcribed interviews and focus
groups that were open coded by the researcher. These concepts included the leadership
characteristics identified with the facilitation of culture change and retention in an aging services
organization: transparency, trustworthiness, connectivity, accountability, empowerment, and
optimism. Concepts were derived from stories shared by participants, words they used to
describe events and experiences in both the old and new culture, memos and observations of the
researcher during two week-long site visits, and a content analysis of published and proprietary
materials such as employee satisfaction reports, newspaper clippings, internal house organs,
annual reports and related information sources.
Once the initial concepts were coded, the researcher examined the literature surrounding
the six concepts to more fully understand their properties and dimensions. This clustering
strategy is a way of sorting through data, allowing the researcher to view them at many different
levels. For example, because the research is considered an embedded case study examining
several layers deep within the organization, each of the six concepts identified were checked to
see if they existed at both the campus and home office level of the organization. The researcher
was careful to ensure that each of the concepts resonated into the depths of the organization.
Where they did not, disconfirming evidence was noted. The disconfirming evidence associated

each concept was identified as a way of adding validity to the data. Miles and Huberman (1994)
state that theory building relies on a few general constructs that subsume a mountain of
particulars (p. 18).
Each of the six concepts was supported by the data and six connector concepts linking
each of the six major concepts also emerged from the data during microanalysis. The connectors
include: authentic actions, connecting transparency with trust; value congruence, aligning trust
with connectivity; organizational legitimacy, which bridges connectivity and accountability;
information accessibility, connecting accountability with empowerment; locus of control, linking
empowerment and optimism, and self-efficacy, which generates optimism, leading to
transparency. The conceptual framework that follows reflects the six major leadership
characteristics with the six connector concepts, depicting how they interface with one another.



authentic actions



locus of control

change and







Figure 3. Conceptual framework of leadership characteristics and connector concepts leading to

culture change and employee retention.

Conceptual Framework
According to Miles and Huberman (1994), explicit theory is a set of concepts organized
in a particular fashion (p. 91). The conceptual framework above depicts the linkages among the
six identified leadership characteristic concepts and culture change. The connectors between
each of the six concepts attempt to define how one concept directly links to the other next to it,

as revealed by the data collected in this qualitative study. In this way, the six major concepts
identified by the researcher are linked by these connector concepts. This exploration of
connectors from one major concept to the next is carried out in an attempt to find deep
structure, and then integrate the data into an explanatory framework. Gherardi and Turner
(1987) called this data transformation, as information is condensed, clustered and sorted.
Explanations of each second order concept follow.
Connector Concept 1: Authentic Actions
This link seeks to name the way that transparency leads to trust. Bennis and Nanus (2002)
and George (2003) argue that leaders usually go through a crucible experience before they can
be truly authentic to followers. This experience can occur in childhood or later in life. The CEO
of the organization studied shared two experiences where there was a leadership crisis and she
was forced to confront her fears and move into action. It was through these two experiences that
she realized, first, that she had the capacity to lead, and, second, that she had the ability to
persevere despite the odds. The first crucible experience occurred in her 20s, and the second
occurred in her late 40s. One built upon the other and allowed her to discover her authentic self.
She also realized that the more she did not pretend to have all the answers, the more people
trusted she had the ability to discover them. Every person interviewed with the exception of the
five residents who participated in this study (none had ever met the CEO), spoke about the quiet
but powerful manner in which the CEO did her work. The trust level was high (as evidenced in
the stories they told), and when asked if it bothered them that she was not sure how the vision
would exactly be achieved, it was clear that her admission that she did not have the answer at the
present time actually increased the trust level they had in this executive. This phenomenon,
which is counterintuitive in some sense, occurs in large part because of the previous reputation

this individual brings to the organization. Her career is well-documented on the state level, and
she is regarded as extremely skilled and competent. Without this underpinning, her transparency
might have been labeled cluelessness, but the combination of perceived competence (also
known as ability in the Meyer et al. trust model), combined with her I dont know it all
humble attitude (in Collins Level 5 leadership) leads to trust. For example, consider this
dialogue between the researcher and a board member who had served on the board during the
reign of the previous CEO, and now serves again as a member of the board of trustees:
Interviewer: Does it concern you that the current CEO, in her own words, doesnt have
all the answers about how the vision is going to be achieved over the next 5 years?
Board member: No, I think that is the difference between the current CEO and the former
one. The former CEO felt as though he had all the answers. Our current CEO says to
usthis is the direction we want to go, and were going to do it together and were going
to learn how to do it together. The openness of saying you know, I really dont know,
but were going to do it. And were going to take it as it comes. We dont know exactly
how were going to get there, but we are going to get there is quite refreshing. We know
she will do itshes done it many times before other places.
This conversation illustrates that it is the authentic behaviors and actions of the CEO that
act as the link between transparency and trust.
Connector Concept 2: Value Congruence
The alignment of values, among individual co-workers, between leaders and their
followers, between personal missions and the mission of the organizationis the link identified
by the researcher between trust and connectivity. It is the glue that allows workers to understand
where they fit in the larger picture; a way of connecting the dots between who people are as
individuals and their role in the organization. Value congruence sometimes happens as a result of
people working together for extended periods of time, but more naturally, the congruence of
values is something felt in a visceral way between co-workers. In the case of the organization

being studied, the CEO brought to the home (corporate) office executives with whom she had
worked within other settings. Because the values were aligned in terms of what needed to be
accomplished (and importantly, how things needed to be accomplished) the culture could evolve
more naturally and more swiftly than if the values of key players had not been aligned. A
perspective is shared by a middle manager in the home office:
I am amazed how far we have come as an organization because I would say the first year
was spent with a lot of people digging in their heels. And she just kept moving forward,
you know, but she did it in a very respectful way. She allowed people their grieving
period. She tried to figure out what they were about, what their personal visions were.
You know, she allowed people to grieve the loss of the old, to feel bad about it, to get
angry about whatever it was they wanted to feel. I would say that took probably 18
months actually. Other leaders might have come in and just saidI want all of you gone,
see you later. She did not do that. She gave everybody an opportunity to be part of the
new culture and our vision for moving forward. Everybody had the same opportunity
she sought out their input.
The value that became apparent to the CEO was the dedication of the workers to their
clients and the strong desire to deliver high-quality care. She discovered that despite the old
culture, the field had developed its own sub-cultures of excellent, dependable care. This was
particularly evident at the low-turnover campus. Upon discovering this value, the CEO aligned
with it and reinforced it by rewarding innovations that supported the value. For example, a new
technology innovation called Quiet Care is designed to proactively help residents manage their
care so they are able to identify health issues before they escalate into major health problems.
This is a dimension of quality that dovetails with the notion of Living Fully After 50.
Connector Concept 3: Organizational Legitimacy
Organizational legitimacy comes about, according to Massey (2001), when
organizational actions are consistent with stakeholder expectations (p. 156). Internally, this


occurs when leaders uphold their promises and commitments to followers. The CEO spoke to
this notion, saying:
The field had been real distrustful [of the former organization] and that is the way it had
always been. So then I tried to be really, really consistent, and I tried toI would say to
them if I tell you Im going to do something, Im going to do it. So I would only
promise anything I knew I could do. So they wouldnt sit in a group at the bar later and
say, oh right, she told us shed this, just like (former CEOs name) did and it never
happened. So I tried to set pretty low expectations [that for them were huge] so they
could start to trust my word.
Externally, organizational legitimacy can come about in many forms and manifest itself
in a variety of ways. On form at the organization studied was the awarding of a Great Places to
Work designation. This award was bestowed on the organization 2 years in a row and it is the
only time a regional aging services organization has achieved such a designation. The house
organ, Insider, regularly features local awards and honors bestowed on the local campuses, as a
way of demonstrating legitimacy to the employee stakeholders. In this way, the organizational
legitimacy is raised even higher.
Connector Concept 4: Information Accessibility
Just as the Insider house organ attempts to keep all employees abreast of what is going on
at the organizations 37 sites in four states, other mechanisms that transmit information are
utilized extensively at the organization, most notably, the Dashboard. The Dashboard outlines
the organizations key performance measures, put on paper and distributed to every manager
within the organizational system. This is the way the organization keeps score and knows
whether it is reaching its goals. Sharing information of this type links accountability with
empowerment. The practice of making information accessible to front line personnel is the
antithesis of the mystery that shrouded the organization in its previous life under an authoritative
CEO who kept everything close to the vest as one interviewee put it. By sharing information, it

is clear to employees what the goals of the organization are, and how their role connects to those
goals. For example, administrators at the campuses know that creating a feeling of home and
responsiveness to choice are two key indicators by which their facility will be evaluated during
the annual resident satisfaction study. Each individual campus is graded on these factors.
Therefore, campus administrators take into consideration the choices their residents have during
meal time, and become more flexible and person-centered about when and how bathing routines
get carried out, for instance. This empowers the campus staff to think of creative ways to allow
flexibility and choice, within the constraints of the state survey system and other prescribed rules
and regulations, over which they have only moderate control.
Connector Concept 5: Locus of Control
Those with an internal locus of control see themselves as responsible for the outcomes of
their own actions and they see themselves as being a chief determinant of their own destinies.
Those possessing an external locus of control see environmental causes and situational factors as
determining their fate. A term developed by Julian Rotter in the 1950s, locus of control has an
interesting relationship to the concepts of empowerment and optimism. Psychological
empowerment, according to Spreitzer (1995), is about self-determination (the feeling of control
over ones work and autonomy) and an internal locus of control, and similarly, people who are
optimistic tend to see good events as something for which they can take responsibility and credit.
Structural empowerment (Kanter, 1977) enables employees to accomplish work in meaningful
ways and with creativity and is facilitated by offering opportunity, information, support,
resources and formal/informal power. It is measured by asking whether supervisors and the
organization provide the tools and resources needed, whether leaders resist the tendency to
micromanage others, whether information is freely shared, and whether career advancement

opportunities exist. It would follow that if structural empowerment existed within an

organization, there would be a sense of optimism, based on the idea that followers have more
control over their work destinies, more freedom to realize their own potential and aspirations, as
well as the organizational goals they are striving to meet. According to Seligman (1990), people
who are optimistic are less likely to feel victimized and fall prey to a phenomenon known as
learned helplessness (p. 30).
Here are some selected quotes about the sense of internal locus of control and optimism
present within the organization studied:
Home Office Executive: The CEO gives people the freedom to do what they need to do.
She may have ideas to help point a person in a direction, but she gives them the freedom.
And also if we need to figure out how to do something, we also need to figure out what
resources are required. We have a lot of control over how work gets done.
Board Member: People here are positive. There always are some pessimists, but theyre
not the norm. The majority of people here dont like working with people that arent
happy and friendly.
Campus Administrator: I try to be positive. You know, I think when you like what youre
doing and if you like where youre working, even if youre kind of a negative personality,
it doesnt snowball because you dont have other people to complain with, to pull down
with you. I like the philosophy of getting decision made by the people on the front line. I
dont want my employees to run to me for answers. You know, they can make that
decision themselves. My job is to create a supportive environment, and to see that they
get what they need. Ive got a lot of good people and I trust them to make good decisions.
They have control, they like knowing they can decide HOW to do things, and that makes
everybody feel trusted and optimistic.
Field Manager: Weve developed a certain culture here the people kind of self-select
intoour employees are upbeat, positive and like to be empowered to make decisions.
They know they are in the drivers seat.
Home Office Middle Manager: I really like the can-do attitude, the enthusiasm, and the
willingness to try something. It is an upbeat place. And I think working in a positive
atmosphere is very important because if it were negative, thank you, I dont care to be


These quotes and the general feel of the organization as a positive environment reflect the
presence of empowerment, optimism and the link between the twoa strong internal locus of
control on the part of leaders as well as followers.
Connector Concept 6: Self-Efficacy
Albert Bandura introduced the notion of self-efficacy in the early 1980s. It is related to
locus of control, but is not the identical concept. An example of the difference would be the case
of an aspiring hockey player who believes that training 6 hours a day on the ice may improve his
ability (internal locus of control) but does not believe he is capable of devoting that type of
energy to his sport (low self-efficacy). Bandura (1982) posits that self-efficacy is a personal
belief about how well one can execute a particular course of action. Like optimism, selfefficacy in creating major change in specific domains will likely predict transcendent behavior,
according to Bateman and Porath (2003, p. 122). Transcendent behavior is self-determined
behavior that overrides constraining personal or environmental factors and effects extraordinary
(positive) change (p. 122), leading to high self-efficacy. We consider behavior to be
transcendent when it overrides environmental contingencies or apparent personal limits and
creates extraordinary change in the person or in the environment (p. 123).
Optimism and self-efficacy, then, are closely related. When individual workers are
optimistic and possess self-efficacy they feel more comfortable with themselves and their
organizations, and it would follow that they would also become more transparent and authentic
with themselves and their co-workers. This is especially true when they have heard their leaders
admit I dont have all the answers. The quotes below support this connection:
Certified Nursing Assistant, Low-Turnover Campus: I am really good at what I do, and I
take a lot of pride in my work. But if I screw up, it is OK. My supervisors philosophy is
that we learn from our mistakes, and she readily has admitted her own. She sees it as a

learning opportunity. She has told me if I am not making mistakes, Im not learning
anything, not stretching myself enough. So when I make one, I dont beat myself up. I
can be myself. I have the freedom to make mistakes and still be seen as a competent
Director of Nursing: The person I work for is very supportive of me and my work. There
is no second-guessing going on you know it is kind of like I am accepted
unconditionally. There is an atmosphere of forgiveness, an atmosphere of grace. I feel
valued for who I am, I can show my true colors and know it is fine.
Home Office Middle Manager: Even when I dont necessarily believe in myself, my boss
does. That goes a long way in making me feel like I am capable of anything in this

Through utilization of open and axial coding, the researcher was able to identify six
major concepts and six connector concepts (or behavioral links) that explain how leaders are
affecting deep culture change and retention in an aging services provider organization.
Microanalysis, which is a detailed line-by-line examination of words transcribed from interviews
and observations made by the researcher, was utilized to suggest relationships among the various
categories of concepts. This coding strategy relies on the researcher to discover connections
among issues and themes. Also useful to the researcher was the identification of theoretical
underpinnings associated with the six major leadership characteristic concepts by major theorists,
leading to a dense texture of relationships (Strauss, 1987, p. 64). In addition, disconfirming
evidence was noted, sorted by the six major conceptual elements of transparency, trust,
connectivity, accountability, empowerment and optimism.
By re-reading the transcripts, field memos, observation notations, and secondary
information provided by the organization, the researcher was able to discover the connector
concepts of authentic actions, value congruence, organizational legitimacy, information

accessibility, locus of control and self-efficacy, which serve as the glue to bind the six major
concepts together in a theoretical framework. Together, the 12 concepts formulate the DNA
required to affect deep culture change in an organization that had operated under a very different
culture and structure for decades.



The research question addressed in this qualitative study utilizing flexible design was:
What type of leadership style engenders culture change and retention in an aging services
organization? This chapter presents a summary of the researchers major findings, as well as
The embedded case study involved examination of a non-profit aging services
organization at the corporate (home office) and grassroots (campus) levels. The intent of the
research was to uncover specific leadership characteristics that lead to culture change and
retention. Since retention is a major challenge in this field, the research is believed to be
important, providing useful and practical guidance for the cultivation of certain leadership
characteristics through training, educational seminars, and other developmental efforts.
Characteristics discovered among successful leaders at the organization studied are:
transparency, trustworthiness, connectivity, accountability, empowerment and optimism. In
addition, six connector concepts that serve as the glue binding these characteristics to one
another were uncovered: authentic actions, value congruence, organizational legitimacy,
information accessibility, locus of control and self-efficacy.
An examination of these characteristics in light of three established leadership models
(transformational, Level 5, and servant leadership) leads the researcher to conclude that a new
blended leadership model suited to the aging services field can be successfully developed. It was
found by the researcher that many of the constructs of transformational leadership (Bass &

Avolio, 1990) matched the leadership characteristics discovered as necessary for culture change
and staff retention. These findings are consistent with those of Thyer (2003) and Naude (1995).
However, it was discovered that two of the six leadership characteristics found in this study are
not embedded in the transformational leadership model, namely transparency and accountability.
These two characteristics are prominent in both the Level 5 and servant leadership theories.
Because the six leadership characteristics are found collectively in these three leadership
theoriestransformational, Level 5 and Servant leadershipthe researcher posits that a blended
leadership model incorporating the 6 key leadership characteristics specific to aging services
could be successfully developed.
It is interesting to note that empowerment was the only leadership characteristic
identified by the researcher in the original framework created for this study. Empowerment has
been widely studied by health services researchers (Bowers, Esmond, & Jacobson, 2003; Euson,
1994; Laschinger & Finegan, 2005; Manion, 2004; Parsons et al., 2003; Pennington & Magilvy,
2003; Stone, 2001; Thyer, 2003) Therefore, it came as no surprise that empowerment was found
as a key leadership characteristic contributing to culture change and staff retention.
Trustworthiness, another of the six characteristics, emerged as an important leadership
characteristic in Arrudas (2005) and Laschinger and Finnegans (2005) work, and researchers in
other fields have conducted studies that identified trust as vital to transformation and culture
change. For example, Podsakoff, MacKenzie, Moorman, and Fetter (1990) conducted seminal
work on the role of trust in the creation of a transformational environment in the petrochemical


Accountabilityin the form of disciplined people, disciplined thought, and disciplined

actionwas noted by Collins (2001) as key to creating a strong culture that would sustain itself
over time.
Luthans and Avolio (2003) identified optimism as a critical component of transformation
in their study of leadership.
The characteristics of transparency and connectivity are not well-grounded in research
surrounding the issue of culture change. The discovery of these two leadership characteristics as
important to transforming culture and impacting retention in the workforce contributes new
knowledge to the field of aging services.

Other Findings Important to Note

Another finding that was not part of the original research question, but emerged from the
data, was a striking similarity between the leadership philosophies and styles of the CEO and an
administrator who is credited with dramatically decreasing turnover on her campus. This campus
is a microcosm of the larger organization and represents the ideals set forth by the CEO,
illustrating a phenomenon identified by Schein (2004): Whether leaders are conscious of it or
not, they evolve midlife organizations culturally by assessing the strengths and weaknesses of
different subcultures and then biasing the total culture toward one of those subcultures by
systematically promoting people from that subculture into power positions in the total culture
(p. 303). The campus administrator with the low turnover rate is heralded throughout the
organization as an example of effective leadership from the middle of the organization. This
administrator has been promoted to a highly-visible regional position, and is expected to
encourage a duplication of the culture she has created on her own campus at other campuses

throughout the system. The CEO has several key individuals within the organization who she
regards as the keepers of the culture within the organization, and the campus administrator is
among this group.
Although the two leaders most closely studied in this case (the CEO and the campus
administrator with low turnover) have very different leadership backgrounds, both have driven
change within the organization using similar approaches. Beer and Nohria (1990) discussed the
Theory O method of culture change, describing it as a soft approach where the leader is intent on
listening and learning about the organization from all venues. The ultimate goal of this theory of
culture change is to develop a culture that embraces empowerment and a core set of
organizational values.
Most people interviewed within the organization studied agreed that culture change is
occurring rapidly (especially in the home office and at the campus with low turnover), but has
not yet totally permeated the organization. There are, for instance, campuses where pieces of the
cultural framework are not as evident. One campus where a sizable capital investment has been
made is led by an administrator who has yet to embrace the accountability mandate. This
administrator, while competent in clinical aspects of her position, has not embraced fully the
need to change or learn what others have to teach her. Because of her long tenure in her position
(and the strong feeling that she has the experience and expertise to carry out her job function
competently) she seeks to control her environment and is not seen as particularly empowering. A
small but telling example of this I know what I am doing attitude was evidenced when a home
office manager concerned with marketing gently challenged the administrator about requiring the
use of a visible and institutional-looking hairnet on a caf worker who interfaces regularly with
the general public. The administrator at this campus responded in an almost hostile manner to the

suggestion, stating that the hairnet was regulation, and appearances were less important than
the rules. This by the book attitude demonstrates a resistance to the type of openness
displayed by others within the organization, particularly the CEO and the low-turnover campus
administrator. The change-resistant administrator is in the process of being assigned to a more
traditional nursing home campus because she is seen as hindering progress. This is one example
illustrating the reality that culture change takes time, and some individuals do not adjust well to
it, even when those around them are emphasizing it on many fronts.
Resistance to change, as Klein (1996) pointed out, often surfaces when old values and
methods are implicitly challenged. Therefore, another salient finding of the research conducted is
that culture is ever-evolving, and that some employees will embrace it more quickly than others.
A research question yet to be explored is why some employees, even when surrounded by
structural empowerment (Kanter, 1993) and leaders who encourage change and innovative,
remain resistant to change and attempt to sabotage it, either knowingly or unknowingly.

Application of the Conceptual Framework

The organization studied is steeped in the process of culture change, spearheaded by a
CEO who demonstrates authentic actions through transparency, which leads to trust building.
Authentic actions also drive the messages communicated by the campus administrator where
turnover is low. This administrator has been described by her subordinates as an approachable,
genuine, what you see is what you get type of individual who imbeds both psychological and
structural empowerment into her campus. Co-workers at both the corporate and campus levels
speak of the value congruence they experience between what is held dear to the CEO and
campus administrator and themselves, articulated as a deep commitment to serving residents and

their families, and providing as many choices as possible to them. Both the CEO and
administrator foster connectivity within the organization by making it easy for individual
communication and networking to take place, and through demonstration of benevolence and
concern for fellow workers as well as persons served. The CEO in particular is concerned with
organizational legitimacy as evidenced by the pride felt upon designation as a Great Place to
Work and editorials regularly written in the regional press speaking to the need for culture
change in the way seniors are allowed to age in societyon their own terms, not by institutional
Accountability is underscored at both the corporate and campus level where low turnover
is evident. In fact, when the researcher asked for a detailed accounting of turnover information,
the campus administrator readily supplied up-to-date, detailed statistics outlining the rate of
turnover by position type. The CEO has pushed for the development of metrics by which the
organization as a whole measures quality progress, and the campus administrator studied fully
supports and promotes the promulgation of this information, communicated as the Dashboard
to the rank and file. Accessibility to information is provided at the corporate and campus level, as
the researcher was impressed with the informed response of focus group participants
representing direct care workers at the campus with low turnover rates. These direct care workers
felt a strong sense of empowerment, and repeatedly mentioned that they were given both
authority and responsibility for decision-making at the campus. The word supportive was used
numerous times in reference to the campus administrator and the environment in general at this
Psychological empowerment, which includes the four key components of meaning,
competence, self-determination and impact, was illustrated in the examples and stories provided

by these campus workers. For example, a housekeeping worker at the campus spoke of her
mission to make sure the elderly she serves feel engaged and useful in their daily living, and
told how she invites residents to dust along side of her while they talk about issues of the day. An
environment where rules and protocols dominate the workplace would not empower a frontline employee to operate in this fashion. It is because of the internal locus control felt by workers
on this particular campus that they feel free to make such judgment calls in the best interests of
their clients, even if those calls are considered non-traditional in nature.
So too is the internal locus of control evident at the home office where the Small Minds
Innovation group is empowered to bring forth non-traditional concepts and ideas for new
products and service offerings. The attitude of the CEO is apparent with regard to such
innovative and out of the box thinking: the more the better. She publicly praises those who are
bold and confident enough to suggest new ideas, no matter how contrary to the norm.
Both at the corporate and campus levels, optimism and hope are in evidence. Employees
working in these two environments look forward to shaping the future of aging services by
offering services untried in their region. Ideas such as a continuing care retirement community
and devices that allow health indicators to be monitored while seniors live life in their own
homes are just a few of the innovative concepts being introduced as a result of the culture change
being driven by a new breed of leadership.

Research Recommendations
Researchers exploring the concept of culture change in aging services organizations may
wish to investigate whether it is vital to the success of the transformation that both the CEO and
influential leaders from the middle of the organization share a common vision for the future for

change to take place. This is one conclusion reached by the author of this dissertation, echoing a
notion suggested by Maxwell (2005): Leaders are needed at every level of the organization; and
good leaders in the middle make better leaders at the top (p. 296). The relationships,
philosophies and visions of leaders at various levels within aging services organizations, when
they are aligned and working in tandem, fuels cultural transformation, based on the findings of
this case study. Gadiesh (2005) refers to this idea as distributed leadership whereby leaders at
every level of the organization uniformly send messages about the companys direction (p. 51).
Obviously a single case study has its limitations, namely lack of generalizability. An
assumption was made by the researcher that a focus on a low-turnover campus would reveal
culture change and possibly empowerment, both of which were discovered to be present. This
type of bias threatens generalizability and as Maxwell (1992) pointed out, influences the
conclusions reached by the researcher. Had the researcher, for example, studied a campus where
turnover was high within the same system, it might well have been concluded that culture change
was not as widespread throughout the organization. As Yin (1994) points out if too much
attention is given to (a subunit) and if the larger, holistic aspects of the case begin to be ignored,
the case study itself will have shifted its orientation and changed its nature. However, the
researcher was mindful of this phenomenon and visited several other campuses, in addition to
speaking with the low turnover campus staff, and found that 2 of the 3 other campuses had
embraced the culture.
One of the inherent paradoxes when studying culture change and retention, as with the
case of this investigation, is that often turnover must increase before the desired change can take
place. This was indeed the situation in the home office, within the first 18 months of the CEOs
arrival. The turnover during this phase is estimated by the CEO to have been close to 50%, and

was even greater among the senior staff. While the turnover has greatly stabilized and a culture
of retention is now the norm, a question that begs to be answered is how long will such a culture
last and is the retention based on the presence of the current CEO?
An interesting and worthy study could be conducted when the CEO leaves the
organization to see whether the new culture has been powerful enough to sustain retention.
While strong and trusted leaders like the CEO and the campus administrator instigate culture
change and retention, will these phenomena be present after the leaders have departed? Granted,
this type of research may be challenging to implement at the same organization studied, but it
could conceivably be carried out in another organization that has experienced culture change and
then lost its leader.
Another recommendation for future research is the testing of the conceptual framework
developed from data in this study. Are the six primary and six second order concepts prevalent
within other aging services organizations where a culture of retention is taking place? Are these
concepts universal or indigenous to only the organization studied in this case? Would a different
set of leadership characteristics emerge in other aging services environments, and if so, what
might those characteristics look like?

How the Conceptual Framework Relates to Other Leadership Theories

As pointed out by Thyer (2003) and Naude (1995), transformational leadership is the
style of leadership aligned with lower turnover rates in healthcare organizations studied by these
researchers. The similarities between the constructs of transformational leadership and the
conceptual framework of this study are identified in Table 6.


Table 6. Similarities Between Constructs of Transformational Leadership

Idealized Influence






Value congruence


Locus of control

Authentic actions



There are two leadership characteristics and one connector concept identified in this
research study that do not correlate to the transformational leadership model. These include:
transparency, accountability and organizational legitimacy. However, these aspects of leadership
are strongly represented within Collins (2001) Level 5 leadership model and may be missing
links within the transformational leadership model. A strong undercurrent of Collins leadership
research on Level 5 characteristics is based on the combination of personal humility and
professional will, supported by a disciplined approach to achieving sustained results. Personal
humility carries with it a strong component of transparency, while a disciplined approach
suggests both accountability and organizational legitimacy. It is also important to note that many
of the findings of this research study are supported by Greenleafs (1991) servant leadership
model, including the leader behaviors of listening, empathy, and commitment to the growth of
people (empowerment, trust, self-efficacy), stewardship (accountability) and building
community (organizational legitimacy).
A further recommendation of the researcher, then, is to explore the feasibility of creating
a more holistic leadership theory that combines the work of Bass and Avolio (1990) and others
who have studied transformational leadership, with the work of Collins (2001) and Greenleaf

(1991), which places emphasis on humility as well as a disciplined approach to achieving

sustained results (also known as professional will) and stewardship of organizational resources.

The research findings from the embedded case study suggest that a new leadership model
could be developed from an initial group of 12 leadership behaviors and second-order concepts
or behavioral links associated with successful aging services leaders. These leaders are regarded
as successful because they have demonstrated that certain behaviors encourage followers to
embrace culture change and create higher retention rates. However, because the case study
involved only one organization, additional research is required to determine whether these
leadership characteristics and connector concepts would be present in other aging services
organizations where culture change and turnover reduction have taken place.
A review of three other prominent leadership models (transformational, Level 5, and
servant leadership) suggests that the concepts uncovered in the case study align with the
constructs of these models to create a blended leadership model suited to aging services
organizations. Additional research could test whether these 12 concepts or a blending of the three
established leadership models hold the key to culture change and retention. The researcher
recommends the conduct of a quantitative study of aging services organizations with belowaverage turnover rates contrasted with those posting above-average turnover rates to identify the
presence and/or absence of these leadership characteristics. To carry out such a study, turnover
formulas would need to be uniform and documented. A survey tool that evaluates the presence or
absence of the 12 designated leadership characteristics and connector concepts would have to be
created, and tested for validity and reliability.

The idea that none of the existing leadership theories alone currently explain the
leadership characteristics or behaviors required for culture change and organizational
transformation was noted by Dearlove and Coomber (2005) when they stated: There are many
different theories competing for centre stage, claiming to offer some insight into the direction
leadership should take. The difficulty in identifying the key theories is compounded by the fact
that, while few are completely true, many offer valid insights (p. 55).
Scholars long have debated which leadership theory is the most universal and most
effective. This study raises the idea that three prominent leadership theories, when combined,
represent leadership characteristics necessary for organizational transformation and a culture of
retention (Manion, 2004) in aging services organization. All of the six leadership characteristics
identified in this study are covered by one or more of the three leadership theories of
transformational, Level 5 and servant leadership, lending validity and credibility to the six
characteristics identified in this research study. It is the conclusion of this researcher that a new
model based on these characteristics can be constructed and applied to the field of aging services.
A customized leadership model suited to the field will spawn culture change and staff retention,
two strategies imperative to the vitality and success of the field in the coming decades.


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Thank you for taking the time to meet with me today. I am conducting research for my doctoral
program at Capella University and your participation is important to my research. I am attempting to
better understand the leadership behaviors of the past and present CEOs and their management
teams. Since you worked under both administrations, your insights will be particularly helpful to me
in identifying any differences which might exist between the two leadership styles. Do I have your
permission to tape record this conversation? Everything you tell me will be confidential in nature.
Your comments might be included in my final report, but your name will not be associated with
those comments. Everything you say today will be anonymous. Do I have your permission to
1. Let me begin by asking you to describe the culture of this organization. In other words, what are
the values, the mission and the way work gets accomplished around here?
2. How would you describe, in your own words, the type of leadership at the organization?
3. Specifically would you say that the leaders here:
* emphasize teamwork?
* appreciate creativity?
* communicate what needs to get done, but not exactly HOW it gets done?
* make people feel valued for their contributions?
* encourage innovation and new ways of doing work?
4. In what ways do these behaviors occur or not occur? Is there a difference between the leadership
behaviors of the old administration compared to the new one? How would you describe that
5. Could you share with me the thoughts that come to your mind when I say the word
6. By your own definition, is empowerment taking place at this organization? In what specific ways?
Do other people you know in the organization share your point of view? Who may not share your
point of view?
7. Do you sense that most people working at this organization plan to stay for the foreseeable future?
Why do you respond that way?


8. Are there leaders in the organization who you believe are particularly effective in creating a
culture that makes people want to continue to work here? Who are they? What specific behaviors
have you seen that cause you to name them?
9. If you were to describe this organization to someone you just met (like me) what three words
would you use to describe it?
10. What other thoughts do you have to share with me about the leaders here, the workplace
environment, how people work together or how you feel about this organization and its culture?
Thank you for your time today. Your comments will be kept confidential and I appreciate your
participation in this interview.
Focus Group Discussion Topic Guide #1
Participant Group: Certified Nursing Assistants
Thank you for agreeing to participate in this focus group today. I am a doctoral student at Capella
University and I would like to better understand the leadership styles of your supervisors, the type of
culture at this organization and your impressions about the amount of "power" which is shared with
you on a day to day basis by your leader(s). I would like your permission to tape record our
conversation so I accurately capture your points of view. Nothing anyone says here today will be
attached to your name. Your quotes may be used in my final report, but your individual name will
not be attached to that quote. Transcripts made from the tape recordings will be seen by two persons
only-- myself and a professional, paid transcriptionist based in Pennsylvania. Is it fine for us to
proceed under these conditions?
1. First let me begin very generally by asking you what the atmosphere is like around this place?
Simply give me some descriptive words you and others in the organization would use to tell a
stranger what it is like to work here.
2. Turnover is a big issue in this field of aging services. Why do you think turnover happens?
3. Is turnover a big problem here-- why or why not?
4. Do you think the style and behavior of leaders has an influence on turnover? Why do your respond
that way?
5. What elements must be in place for an employee to want to stay with an organization for the longterm?
6. All of you have now served under two administrations in this organization. How would you
describe the previous group of leaders compared to the present group of leaders? Were their


leadership styles different or similar? If different, how so? Which of the two styles/behavior types do
you believe was most associated with retention of direct care workers here? Why? What else besides
leadership influences whether people stay at an organization and are satisfied with their work life?
7. In general, how has the atmosphere changed (or not changed) since the new administration came
on board? If you did experience change was it positive or negative or something else?
8. Would anyone describe the workplace here as empowering-- meaning you feel like you "own"
your work, and you have some degree of decision-making power about how that work gets
accomplished on a regular basis? Tell me your feelings and impressions about this topic.
9.How would you describe the culture of this organization to a stranger? What is unique (if anything)
about working here?
How do you think this culture came about?
10. Please share with me any other ideas or thoughts you have about the topics we have discussed
here today.
Focus Group Discussion Guide #2: Directors of Nursing
Thank you for agreeing to participate in this discussion today. I am a doctoral student at Capella
University researching the topic of leadership and its impact on organizational culture. My intent
today in meeting with you is to solicit your viewpoints about this organization. Many if not all of you
worked under the previous administration as well as under the current adminstration. I am seeking to
understand what the culture of this place felt like under that administration. I am also interested in
understanding your perceptions about the current culture. I would like your permission to tape record
our conversation today so that I have an accurate account of the words you use to describe your
impressions. Nothing you say today will be tied to your name, however, and your comments will
remain anonymous. Only myself and a professional paid transcriptionist based in Pennsylvania will
see the transcripts of this focus group. Complete confidentiality will be maintained. Although
specific quotes may be included in my final research report, no names or idenitfying clues will enable
anyone to associate your name with a quote. Under these circumstances, may we proceed?
1. For those of you who worked here under the previous administration, would you share with me
some words to describe the environment or culture that you experienced?
2. How is this description different or the same as the way you might describe the current work
environment or culture?
3. How is the leadership of the organization impacting the culture present today? How would you
describe the leadership styles of those you report to?
4. Is there anything you wish were different about the current culture? Would others in the
organization likely agree or disagree with your perception?


5. Talk to me about empowerment. How do YOU define that word?

6. Does empowerment exist here now? Why do you say that? What causes empowerment to happen
or not happen at this organization?
7. Do you consider yourselves leaders who empower your followers? Why or why not? If you do
empower others, how exactly do you do it? Did you receive formal training or leadership
development that taught you how to empower? Please elaborate.
8. If empowerment does exist in this organization, what concrete results or evidence can you point to
that would convince me it is present?
9. Let's talk about turnover. First, do you perceive it to be high, low, somewhere in between? Why do
you have this perception? Has the turnover gone up or down since the new administration came on
10. Is there a relationship between leadership styles/behaviors, empowerment and turnover? Describe
this relationship in as much detail as possible please.
11. Are there any other comments or observations you can make regarding these topics which might
contribute to my understanding?
Thank you for your time today. All comments will remain confidential.


Initial Site Visit



In-depth interviews

CEO & top

management team (7);
Board of trustee
members (3)
Community members
and residents (5)

Week of July 10

Focus groups (2)

Nursing supervisors (6) Week of July 10

and Direct care staff
Week of July 10
Board of directors
meeting; innovation
station team meeting
and executive
management team



Create open-ended
interview guides;
schedule 1 hour
audiotaped interviews
with individuals
recommended by HR
Utilize input from HR
to recruit groups.
Attend board meeting
scheduled for July 13;
hanging around and
observing. Journaling
and memoing.