By Patricia S. DeVoy, PhD, EdS, LPN, RHIA, CPC, CPPM
Health information management (HIM) professionals are a vital component of a global network of healthcare specialists who assure quality documentation, data governance, analysis of data, and medical coding of vital healthcare statistics.1 These healthcare professionals make up a globally diverse community2 which demands leaders with globally transferable leadership skills.
The goal of this study was to explore the application of Servant Leadership Theory3 to job satisfaction through globally applicable and transferable leadership behavior. A case study approach of semi-structured interviews and blog posting entries were examined through the principles of a global mindset.4. Results of this study are applicable to the community of practicing HIM professionals through the identification and examples of the application of effective and globally transferable leadership behavior.
Keywords: Health information management, global leadership, global mindset, servant leadership
HIM professionals are a vital component of a global healthcare workforce who apply their expertise in governing and analyzing healthcare data for security, accuracy, and integrity. There are more than 200,000 HIM professionals in the United States5 and over 32,000 in Canada.6 Due to the globalization of healthcare, the outsourcing of HIM tasks has increased by 31 percent from 2011 to 20167 and international companies based in the United States are hiring HIM professionals from around the world. This has spawned a mosaic of ethnicities in HIM8 who are at the forefront of a digital healthcare industry which has transformed from regional to global and consumed more than or $3.5 trillion, or 18 percent of GDP in 2017.9
It’s projected the United States will see an increase of more than 6,000 HIM positions per year, yet foresee only 2,000 annual graduates from accredited HIM programs.10 In Canada, an additional 12,330 will be needed within the next few years.11 The shift to a global workforce and the projected shortage of HIM professionals presents the importance of providing an organizational climate which promotes job satisfaction. When professionals compare the aspects of a job, allowances for pay and working conditions will be made, but recognition of personal and professional value won’t be sacrificed.12 Identifying globally transferable leadership skills which recognize and nurture the value of the employee is vital to the recruitment and retainment of qualified employees.
Job satisfaction is dependent on the communication and relationship13 between an ethical leader14 and follower. This provided the motivation to explore servant leadership theory through the application of a global leadership approach. Servant leadership behavior is comprised of conduct which “seeks to involve others in decision making, is strongly based in ethical and caring behavior and enhances the growth of workers while improving the quality of the organizational climate”15 and exhibits the behavioral traits and characteristics of serving first and leading second. Yet, within the global society of HIM professionals, exhibiting these leadership traits are not enough; leaders must be able to apply global leadership skills in an environment of global diversity.
An effective leader of HIM professionals must have the ability to motivate a group of people, constructively seek a clear vision and foster growth while working within a globally complex frame of reference.16 The ability to learn and understand at a global level (intellectual capital), the self-confidence to function in a cultural environment different from their own (psychological capital) and the ability to cultivate new relationships with individuals from diverse cultures (social capital) is crucial to serving first and leading second in global diversity.17
Due to the crucial need of globally effective leaders, this research explored the effect of servant leadership theory on job satisfaction as applied through a global mindset of leadership behaviors. Canadian participants were included due to both the United States and Canada experiencing a shortage of HIM professionals and to give the research a global perspective. The context of this qualitative research was framed within the thematic description of 10 servant leadership characteristics18 and the original servant leadership definition of, “The best test is: Do those served grow as persons; do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to be servants?”19 and the merger of global mindset characteristics20 demonstrated in Table 1.
The servant leadership traits of conceptualization, persuasion, building community, commitment to growth and foresight of the future23 were also explored through a definition of global leadership23 shown in Table 2. Please note the original theory of servant leadership was developed in 1970, and the bulk of research following took place within the first quarter century of development. Hence, you will find research and references within this research predominately from the time period of 1970s to the mid-1990s.
The multiple-case study and blog entry format utilized was based on a constructivist approach26 and utilized the Interactive Model of Research Design27 to explore the following questions:
1. How do HIM professionals describe the experience of job satisfaction in the United States and in Canada?
2. How do HIM professionals describe their job satisfaction experiences with leaders who exhibit servant leader and global mindset behavior?
3. How do leaders describe the role they play in the job satisfaction of HIM professionals?
As seen in Figure 1, the Interactive Model of Research Design28 intertwines the goal, conceptual framework, method, and validity with the research questions which allows continual assessment and comparison between each investigative component.
Similarities and differences were explored between participant responses from semi-structured interviews with currently employed HIM professionals in the United States and Canada and an additional cyber-artifact obtained from open forum blog entries. The use of blog entries provided a forum for anonymous participant participation and provided extensive data within a naturalistic context.30 Blog entries also represented the “symbols” of the group and were used to “understand their beliefs, values, and behaviors.”31
Blog entries further allowed a view of the everyday life of the blogger32 with the additional ability of continuous access to data. Both participant interviews and blog entries were focused on the leader/follower perception of servant leadership, global mindset, and job satisfaction.
United States interview participants were procured from the eastern United States, while the interview participants from Canada were procured from both the eastern and western sections of northern Canada. Interview participants were chosen randomly from a request for participation from the website of three different professional organizations for HIM professionals.
Due to not knowing the number of interview participants and blog entries needed prior to beginning this qualitative/case study research, a prediction of ten participant interviews and cyber-artifacts was made. The exploration of data continued until saturation (each new unit of analysis produces very little new data) was reached33 which resulted in conducting 11 extensive interviews. Blog entries of three HIM professional organizations were chosen for their focus population of health information professionals. Blogs were seeded (an initial post regarding general leadership behavior was posted to begin a conversation) and open forum blogs were monitored for 14 days.
Data analysis focused on coding and analyzing for the thematic presence of job satisfaction, servant leadership behavior and an attitude of global awareness within two recognized qualitative strategies- a categorizing strategy (coding) which disaggregated the data into substantive categories and an additional analysis of data by theoretical categories which allowed a comparison with previous leadership theory.34 Substantive categories allowed “open coding” to be performed which permitted an exploration of general, overall concepts within the data while “theoretical propositions”35 of Servant Leadership Theory36 and a global attitude were analyzed. All interview participant and blog participant entries were coded utilizing the 54 codes listed in Table 3.
Due to the large scope of acquired data, in addition to manual coding, the qualitative cross-platform QDAS (qualitative data analysis software) system Dedoose™ was employed to code professionally transcribed interviews and blog entries. This provided the opportunity to “learn about the rich, complex and contextualized ways in which our research participants experience their lives”37 which coincided with the qualitative focus of the study.
Each research question was analyzed for thematic presence of servant leadership behavior and included both interview and blog participant data. Job satisfaction task codes were used to determine the thematic presence of job satisfaction. (See Table 4, Table 5, and Table 6).
The use of case description38 was used in the interpretation of data to find the thematic presence of servant leadership behavioral characteristics and five characteristics of job satisfaction.39 Figure 2 shows a summation of thematic presence by listing the major themes found throughout the data by frequency of both interview and blog participant data.
Table 7 depicts the analysis of the 19 functional attributes of servant leadership,40 with data disaggregated by interview and blog participants and was singled out for analysis due to its servant leadership inclusivity.41 Figure 3 shows 91 percent (10 of the 11 participant interviews) and 100 percent of blog participant entries were coded for stewardship.
Analysis of job satisfaction data included comparing coded results between interview and blog participant data for application of the five job characteristics of job satisfaction42 and the servant leadership categorical, parent and sub-codes developed from the ten-servant leadership characteristics43 are found in 100 percent of all participants. (Figure 4)
Throughout the data, servant leadership themes are dominant and perfectly associated with the presence of job satisfaction in both interview and blog participants.
Unlike quantitative research which has specific statistical calculations, “Theoretical generalization is the domain of case study as what statistical generalization is to the true experiment.”45 This allowed the gleaning of conclusions from the application of “theoretical generalizations.”46 Triangulation of data47-49 was performed through the inclusion of the additional artifact of blog entries,50 obtaining rich data through interviews and blog entries and performing respondent validation through comparison of both blog entries and participant interviews.51
This study broke new ground within two areas of previously unexplored territory of global research through the exploration of servant leadership behavior and job satisfaction within a global mindset and via both interview and blog participant data. The comparison of interview and blog data is a relatively new area of research and provides an endless opportunity of global studies to occur from anywhere around the world via virtual interviews and blog posts.
Due to the non-existence of previous research on servant leadership through a global mindset and job satisfaction via the use of participant and blog data within the health information management community a limitation to this study is an inability to compare results with previous research for enrichment52 or to determine replication for authenticity.53 Currently, the only available comparison is research within other areas of servant leadership and job satisfaction. A systematic literature review of servant leadership and job satisfaction through both qualitative and quantitative means found a direct correlation between servant leadership behavior and increased job satisfaction54-58 yet none of the previous results were attained from the diverse community of HIM professionals.
This research has shown an association of job satisfaction and servant leadership behavior within a global mindset of leadership which is applicable to the diverse community of HIM professionals. There are implications for immediate application within the global leadership and training of HIM professionals by the addition of servant leadership skills applied within a globally focused mental attitude. This research is also provides the stimulus for health information management education to include servant leadership training and application at both the associate degree and bachelor degree level.
This research provides a basis for further research:
- A quantitative study on global leadership/servant leadership and health information management professionals
- A quantitative/qualitative study on leadership behavior and job satisfaction of remote leaders of health information management professionals in the United States and globally
- A mixed-methods study on global leadership mindset and job satisfaction within health information management professionals
- A quantitative study using/comparing/obtaining data from blogs on job satisfaction in health information management professionals
“Leadership is the process of influencing others and a great organization consists of all leaders.”59 To meet the demands of the growing and diverse community of HIM professionals, the future agenda of global leadership research must include the continuation and formalization of the application of globally transferable leadership skills which include the seven constructs of love, humility, altruism, vision, trust, empowerment, and service60 and designates a globally aware servant leader as someone who “has an innate desire to lead by serving, serves to align own beliefs, and strives to meet the highest priorities of others.”61
Patricia S. DeVoy, PhD, EdS, LPN, RHIA, CPC, CPPM, (email@example.com) is program director, health information management and technology, at the University of Detroit Mercy.
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Greenleaf, Robert K. The Servant as Leader. Atlanta: The Greenleaf Center for Servant Leadership, 1970.
Hannay, M. “The Cross-Cultural Leaders: The Application of Servant Leadership Theory in the International Context.” Journal of International Business and Cultural Studies 1, no. 12 (2008), 5-7. http://www.aabri.com/manuscripts/08108.pdf.
Hookway, N. “Entering the Blogospher: Some Strategies for using Blogs in Social Research.” Qualitative Research 8, no. 1 (2000), 91-113. DOI: 10.1177/1468794107085298.
Hunter, J. The Servant: A Simple Story About the True Essence of Leadership. New York City: Crown Business, 2012
Javidan, M., L. Hough, and A. Bullough. Conceptualizing and Measuring Global Mindset: Development of the Global Mindset Inventory. Phoenix: Thunderbird Global Mindset Institute, 2010.
Jex, S., and T. Britt. Organizational Psychology: A Scientist-Practitioner Approach, 2nd ed. Hoboken: John Wiley & Sons, 2008.
Kim, W., and R. Brymer. “The Effects of Ethical Leadership on Manager Job Satisfaction, Commitment, Behavioral Outcomes, and Firm Performance.” International Journal of Hospitality Management 30, no. 4 (2011), 1020-1026. http://www.sciencedirect.com/science/article/pii/S0278431911000417.
Kohlbacher, F. “The Use of Qualitative Content Analysis in Case Study Research.” Forum: Qualitative Social Research 7, no. 1 (2006), 1-31. Research.net/index.php/fqs/article/view/75/153.
Maxwell, J. Qualitative Research Design, 3rd ed. Thousand Oaks: Sage Publications, 2013.
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Nguni, S., P. Sleegers, and E. Deneseen. “Transformational and Transactional Leadership Effects on Teachers’ Job Satisfaction, Organizational Commitment and Organizational Citizenship Behavior in Primary Schools: The Tanzanian Case.” School Effectiveness and School Improvement 17, no. 2 (2006), 145-177.
Parris, D., and J. Peachey. “A Systematic Literature Review of Servant Leadership Theory in Organizational Contexts.” Journal of Business Ethics 113, no. 377 (2013), 377-393. DOI 10.1007/s10551-012-1322-6.
Russell, E. “Servant Leadership Through Distance Learning: A Case Study.” Turkish Online Journal of Distance Education 13, no. 4 (2013), 26-45. https://doi.org/10.1108/01437730210424.
Russel, R., and G. Stone. “A Review of Servant Leadership Attributes: Developing a Practical Model.” Leadership and Organization Development Journal 23, no. 3 (2002), 145-157. https://doi.org/10.1108/01437730210424.
Small, M. “How Many Cases Do I Need? On Science and the Logic of Case Selection in Field-Based Research.” Ethnography 10, no. 5 (2009), 5-38. http://scholar.harvard.edu/files/mariosmall/files/small_ethnography_2009.pdf.
Spears, L. “Character and Servant Leadership: Ten Characteristics of Effective, Caring Leaders.” The Journal of Virtue & Leadership 1, no. 1 (2010), 25-30. http://www.regent.edu/acad/global/publications/jvl/vol1_iss1/Spears_Final.pdf.
Spector, P. Job Satisfaction: Application, Assessment, Causes and Consequences. Thousand Oaks: Sage Publications, 1997.
Tsai, Y. “Relationship Between Organizational Culture, Leadership Behavior and Job Satisfaction.” Health Services Research 11, no. 98 (2011). https://doi.org/10.1186/1472-6963-11-98.
Weinholtz, D., and C. Friedman. “Conducting Qualitative Studies Using Theory and Previous Research: A Study Re-Examined.” Evaluation and the Health Professions 8, no. 2 (1985), 149-176. https://www.ncbi.nlm.nih.gov/pubmed/10271781.
Yin, R. Case Study Research and Applications: Design and Methods, 6th ed. Thousand Oaks: Sage Publications, 2018.
Zucker, D. “How to do Case Study Research.” School of Nursing Faculty Publications 2 (2009), 1-9. http://scholarworks.umass.edu/nursing_faculty_pubs/2.