by N. ten Hoven and M. Sivro Workshop 4

1. WORKSHOP IV
SERVANT-LEADERSHIP IN THE
MEDICAL WORLD
Mirna Sivro – Msc. in Business Administration (HRM)
Nelleke ten Hove – Masterstudent Business Administration (HRM) (Almost
Msc ☺)

2. RESEARCH FOCUS
VUmc introduced Servant-Leadership since 2000
Effects were never measured
In 2009 dr. Inge Nuijten and dr. Dirk van Dierendonck
introduced their multidimensional measure for Servant-
Leadership
VUmc was interested in the effects of Servant-Leadership
within their organization

3. RESEARCH DILEMMA
Literature ‘gap’: “Servant-Leadership is a leadership style
that can bring back the trust, and among other things,
increase follower well-being and performance” (Nuijten,
2009:9)
To what extent does Servant-Leadership influence
organizational and individual performance of the Vumc?
(hard and soft performance indicators)
Determination of potential “strategy gap”

4. RESEARCH QUESTIONS
Mirna:
What is the role of Servant-Leadership in creating and sustaining a High
Performance Organization? (hard measure of performance)
Nelleke:
To what extent can a ‘strategy gap’ be identified between how on the one
hand, management and, on the other hand, managements’ subordinates
experience VUmc’s Servant-Leadership strategy, and is Servant-Leadership
related to subordinates’ levels of organizational citizenship behaviour (ocb) via
trust? (soft measure of performance)

5. RESEARCH CONCEPTS I
Servant-Leadership (SL):
“A leadership style that is primarily focused on the growth
and well-being of individuals. Furthermore, a Servant-
Leader has moral character, the wisdom to foresee what is
needed, the ability to meet the needs of people, and the
courage to act on that” (Nuijten, 2009: 8)

6. RESEARCH CONCEPTS I
Servant-Leader characteristics (Nuijten, 2009):
Serving: Leading:
1. Humility 1. Empowerment
2. Standing Back 2. Accountability
3. Forgiveness 3. Stewardship
4. Authenticity 4. Courage

7. RESEARCH CONCEPTS II
High Performance Organization (HPO) (hard measure):
“An organization that achieves financial and non-financial results
that are better than those of its peer group over a period of
time of at least five to ten years” (De Waal, 2008: 2)

8. RESEARCH CONCEPTS II
High Performance Organization Factors:
1. High Management Quality
2. High Workforce Quality
3. Long-Term Orientation
4. Openness & Action Orientation
5. Continuous Improvement &
Renewal
Note: these 5 factors contain 35 elements

9. RESEARCH CONCEPTS III
Organizational Citizenship Behaviour (OCB) (soft measure):
“Such gestures as constructive statements about the
department, expression of personal interest in the work of others,
suggestions for improvement, training new people (…), care for
organizational property, and punctuality and attendence well
beyond standard or enforceable levels” (De Gilder et al., 2008)
Behaviours that go beyond the “call of duty”

10. RESEARCH CONCEPTS IV
Trust in Leader:
The level of confidence that a subordinate has in the leaders’
competence and his or her willingness to act in a fair ethical
and predictable manner (Nyhan & Marlowe, 1997)

11. RESEARCH CONCEPTS V
Strategy Gap:
“The gulf between strategies conceived by top management and
awareness at lower levels” (Floyd & Wooldridge, 1992)

12. RESEARCH DESIGN
+
Figure 1: Integrated Research Design

13. SAMPLE COMPOSITION
• 570 respondents contacted by letter
• 100 departments in which 1 manager and 5 of its subordinates
were represented
• 89 usable respondents for the analysis
• Responsrate of 15.6 %
• Representative? – vraag Thijs

14. HPO RESULTS VUMC
HPO results VUmc compared to the sector and Top 3
10
9
8
7
6
5 Cure and Care Sector
4 VUmc Score
3 Top 3 NL
2
1
0
Management Quality Openness and Action Long Term Continuous High Workforce
Orientation Commitment Improvement and Quality
Renewal
Figure 2: HPO score Vumc compared to the sector and Top 3 performers

15. RESULTS I:
SERVANT-LEADERSHIP
AND HPO
• Using the existing SL and HPO literature a theoretical
comparison was made between the factors and elements of
these concepts
• In order to determine the (possible) influence of
SL factors and elements on the HPO factors and
elements a correlation analysis was done.
• Correlation Analysis per function level

16. RESULTS I:
CORRELATIONS HPO AND SL:
Nursing and Other non leading personnel →
Formal Leader (Administrative Manager)
MQ SL-EMP SL-ACC SL-STEW SL-COUR SL-HUM SL-STBA SL-FOR SL-AUTH
Management Quality 1
Sig. (2-tailed) ,000** ,000** ,000** ,000** ,005** ,004**
N 80 42
Openness and Action Orientation
,000** ,003** ,000** ,017* ,000** ,010**
Long Term Commitment
,001** ,010** ,000** ,002** ,003**
Contineous Improvement
,007** ,001** ,000** ,026* ,005**
Workforce Quality
,000** , ,000** ,000** ,000** ,013*
* Correlation is significant at the 0.05 level (2-tailed)
** Correlation is significant at the 0.01 level (2-tailed)

17. RESULTS I:
CORRELATIONS HPO AND SL:
Nursing and Other non leading personnel →
Informal/Direct Leader (e.g. Medical specialist)
SL- SL- SL- SL- SL-
MQ EMP ACC STEW COUR HUM SL-STBA SL-FOR SL-AUTH
Management Quality 1
Sig. (2-tailed) ,036*
N 80 42
Openness and Action
Orientation
,014*
Long Term Commitment
,008** ,043*
Contineous Improvement
Workforce Quality
,029*
* Correlation is significant at the 0.05 level (2-tailed)
** Correlation is significant at the 0.01 level (2-tailed)

18. RESULTS I:
CORRELATIONS HPO AND SL:
Leading personnel → Informal/Direct Leader
MQ SL-EMP SL-ACC SL-STEW SL-COUR SL-HUM SL-STBA SL-FOR SL-AUTH
Management Quality 1
Sig. (2-tailed) ,000** ,000** ,000** ,009** ,034*
N 80 26
Openness and Action Orientation
,000** ,014* ,000** ,000** ,002** ,009** ,027*
Long Term Commitment
,000** ,002** ,000** ,034* ,030*
Contineous Improvement
,009** ,004** ,018* ,014* ,003**
Workforce Quality
,000** ,002** ,001**
* Correlation is significant at the 0.05 level (2-tailed)
** Correlation is significant at the 0.01 level (2-tailed)

19. RESULTS II:
SL, TRUST AND OCB
Figure 3: Mediation SL, Trust and OCB

20. RESULTS III:
SL DIMENSIONS
AND OCB
Figure 4: SL dimensions in relation to OCB

21. RESULTS IV:
STRATEGY GAP
Significant difference between Managers (formal leaders) and Subordinates
(medical specialists and nurses)
Significant difference between Nurses and Medical Specialists
(informal leaders)
Non-significant difference between Managers
(formal) and Medical Specialists
(informal managers) Managers
Medical
Strategy Gap as indicator for areas
Specialists
to improve with respect to Servant-Leadership
Are nurses “ready” for Servant-Leadership?
Nurses

22. CONCLUSIONS I
• Correlation results show that although there are many positive
correlations between SL and HPO, there are also many
differences between organizational levels and their function
groups within the VUmc. This means that SL does not have the
same infleunce on the HPO scores within the whole organization.

23. CONCLUSIONS II
Specific servant-leader behaviours are positively associated with trust in
leader and ocb.
Servant-leaders Forgiveness - Trust in Leader
Servant-leaders Empowerment & Accountability – OCB
Servant-Leadership positively influences subordinates levels ocb, via trust in
leader.

24. CONCLUSIONS III
Inconsistencies exist between how servant-leadership is experienced on
different organizational levels within the VUmc. However, the size of the
gap is smaller than expected, it functions as an indicator for areas to
improve with respect to servant-leadership.

25. IMPLICATIONS VUMC
Bottom-up Approach
Representatives for employees
throughout organizational levels
Nurses
Efforts to incorporate
Medical
servant-leadership in the “heart Specialists
and mind” of every single VUmc employee.
Managers

26. DISCUSSION POINTS
• Could it be that servant-leadership is only successfull in a
specific (serving) organizational context?
• Or is there a need for servant-leadership in commercial
organizational contexts and settings (retail, banking
sector)?
• Are all 21th century employees ready for servant-
leadership?

27. THANK YOU FOR YOUR
ATTENTION
Are there any questions?