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Health Service Organizations and Management


The phenomenon of organizational culture and leadership has continued to be a predominant topic in

healthcare and in businesses. Leadership and organizational culture is the driving force behind the

success or failure of an organization. This paper will examine leadership in a health care facility. The

paper will then present the relationship between leadership and structure, and culture of this



Nursing literature has not fully covered the constructs of leadership and organizational culture as

compared to other field like in business. The available materials major on the role of leadership

especially of the chief nurse executive with little attention to nurse mangers and nursing leadership.

Every effective organization has leaders who demonstrate transformational behaviors of leadership.

The nursing managers have the role of creating and implementing a vision to be accomplished by the

staff members. They are in charge of empowering the staff members with a vision which will bring

positive changes to the health care organization through inside side and outside interaction.

Role of leadership in an organization

Health care organization leaders demonstrate appropriate styles and behaviors that best suits the

complex and constantly changing system of health care. Such changes include change of technology

into more sophisticated ones, nursing shortage, time and cost constrained work environment,

challenge of achieving the desired patient outcomes and increased patients patient acuity (Mathena,

2002, p 136-142.).The role of leaders is to impalement strategies related to achieving the goal of the

health care system even with the limited resources. The roles of leaders in a health care organization

motivate staff members to go beyond self interest for the general good of the organization. The staff

members have to be molded into unit based and clinical leaders by the leaders. They also have to

elevate the staff performance (Ohman, 2000; Robbins & Davidhizar, 2007, p 46-54.).Despite that

challenges that organizational leaders face they have to develop strategies that will ensure there is high

quality of services the health center provides to the patients through cost effective patient care.

Therefore customer’s satisfaction should always be the ultimate goal of the leaders. The leaders have

the responsibility of utilizing transformational leadership styles that will assist the leading team to

address the challenges faced in the organization as it aims at achieving its goals (Tourangeau &

McGilton, 2004, p 182-189).

Leaders should ensure nursing job satisfaction, retention and healthy work environment. The nursing

unit should high levels of mission traits and adaptability. The leaders on the other hand have frequently

utilized leadership behaviors that will shape the culture of the nursing unit. This is through adaptive and

innovative measures of nursing care. This is with the aim of maintaining and achieving organizational

effectiveness in the systems of health care delivery. Leaders who practice transformational leadership

style enable the staff members to have a clear understanding of what is expected of them and the
external forces that affect their practice in nursing. The key role of organizational leaders is to inspire,

motivate, and individually consider that the challenges faced by the staff members. The leaders solve

problems faced by the nurses at an individual or organizational level. This will allow staff members to

have the spirit of self actualization in order to achieve their individual potential for the success of the

organization. Positive skills practiced by the leaders allow the nursing staff members to achieve extra

ordinary goals, through enabling and encouraging them to function beyond their self interest. This is

despite the various turbulent health dynamic changes experienced in health care provision systems.

The relationship between leadership to culture and structure

The culture of an organization controls the performance of an organization and how effective it

will be (Denison, Haaland, & Goelzer, 2003). Leaders in a health care system play a major role in

determining how success the nursing unit will perform. Leadership is the pivot through which the staff

members will perform their duty of acute care in the hospital setting. The priority and strategy plan of

every health care organization is to ensure quality, patient safety, cost effective patient care, quality and

patient satisfaction. To accomplish this, the nursing unit has to be aligned with the hospital strategy

plans so as to achieve the objectives and goals of the hospital.This therefore shows that leadership and

organizational culture are two important elements in an organization that should operate as one in

influencing organizational performance. Nursing managers and leaders who have used transformational

leadership styles have witnessed positive impacts and outcomes of an organization (Robbins &

Davidhizar, 2007, p 234-239). These positive impacts include staff retention, and friendly work

An organizational structure that that encourages constructive organizational culture shows high level of

patient satisfaction while that which does not, has negative impacts to the quality of service offered at

the hospital. It also negatively affects the retention of nurses. This clearly shows that organizational

culture and leadership has an overall impact on the performance of the organization. Denison’s

Organizational Culture Model (DOCM) is a conceptual framework that describes the four traits of an

organizational culture. The characteristics of an organizational culture according to the model are

mission, adaptability, consistency and involvement (Denison, 2005; Denison et al., 2003) There is a

relationship between management style of leadership and the nursing unit organizational culture. The

way the leaders perceive the nursing unit in terms adoptability and mission will determine how an

organization will operate. Similarly, the way the nursing unit perceives the leaders in terms of

consistency and involvement also affect the performance of the organization. These are the variables in

Denison’s Organizational Culture Survey which describes the organizational culture of a health care



Leadership style in any organization is positively related to the organizational culture of any nursing

unit. Good skills of leadership have a positive impact on the culture of the nursing unit. Similarly,

negative leadership has a negative impact of the nursing culture. The two affect and determine how the

organization will perform. The leaders of the organization have both external and international roles to

perform in ensuring the customers are satisfied with the kind of health service offered. They have

duties to perform in ensuring the staff members are content through motivation, problem solving and
staffs retention. The governing body has to be aligned with the nursing unit in order for the health care

system to achieve its goals and objectives.


Denison, D.R., Janovics, J., & Young, J. (2005). Diagnosing organizational cultures: Validating a model and

method. Retrieved from

On May 24, 2010

Mathena, K.A. (2002). Nursing manager leadership skills. Journal of Nursing Administration, 32, p,136-


Tourangeau, A.E., & McGilton, K. (2004). Measuring leadership practices of nurses using the leadership

practice inventory. Nursing Research, 53, p182-189.

Robbins, B., & Davidhizar, R. (2007). Transformational leadership in healthcare today. The Health Care

Manager, 26, p 234-239.

Ohman, K.A. (2000). The transformational leadership of critical care nurse-managers. Dimensions of

Critical Care Nursing, 19, p, 46-54.