ROLE OF LEADERSHIP ON RETENTION OF HEALTH
WORKFORCEIN PUBLIC HEALTH FACILITIES,
2022
TABLE OF CONTENTS
DECLARATION...........................................................................................................ii
DEDICATION..............................................................................................................iii
ACKNOWLEDGEMENT...........................................................................................iv
ABSTRACT....................................................................................................................v
LIST OF TABLES.........................................................................................................x
LIST OF FIGURES......................................................................................................xi
ABBREVIATIONS AND ACRONYMS...................................................................xii
OPERATIONAL DEFINITION OF TERMS.........................................................xiii
CHAPTER ONE:INTRODUCTION...........................................................................1
1.1 Background of the Study...........................................................................................1
1.2 Statement of the Problem.......................................................................................3
1.3 Study Objective.....................................................................................................5
1.4 Research Hypothesis..............................................................................................6
1.5 Justification of the Study.......................................................................................6
1.6 Limitations.............................................................................................................6
1.7 Delimitations..........................................................................................................6
1.8 Significance of the study.......................................................................................7
1.9 Assumptions of the Study......................................................................................7
CHAPTER TWO: LITERATURE REVIEW.............................................................8
2.1 Introduction...........................................................................................................8
2.2Literature Review.......................................................................................................8
2.3 Health managers leadership competencies of health care managers and retention of
health workers................................................................................................................10
2.4 Managers leadership styles and retention of health workers...................................18
2.5 Managers leadership qualities and retention of health workers...............................31
2.6 The impact of leadership on employee retention.................................................33
2.7 Theoretical Framework........................................................................................34
2.8 Conceptual Framework........................................................................................39
CHAPTER THREE:....................................................................................................40
3.1 Introduction.........................................................................................................41
3.2 Research Design..................................................................................................41
3.3 Site Selection and Description.............................................................................41
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3.4 Target Population.................................................................................................42
3.5 Sampling procedure and the sample size determination......................................43
3.6 Research Instruments...........................................................................................45
3.7 Ethics when working with children and sensitive information...........................46
3.8 Reliability of the Instrument................................................................................46
3.9 Validity of the Instruments..................................................................................48
3.10Pre-Test Results......................................................................................................48
3.11 Data Collection Procedures.................................................................................49
3.12 Data Analysis.......................................................................................................50
CHAPTER FOUR: RESULTS ANDDISCUSSION.................................................51
4.1 Introduction..............................................................................................................51
4.2Respondents’ Characteristics....................................................................................51
4.4 Assessment of Leadership Competency Skills........................................................56
4.5 Assessing Leadership Styles....................................................................................76
4.6 Assessment of Types of Leadership........................................................................81
4.7 Leadership Qualities................................................................................................87
4.8 Perception of Leadership at Health Facility............................................................88
4.9 Reason for retrenchment..........................................................................................92
4.11 Level of current staff turnover...............................................................................94
4.12 Inferential statistics................................................................................................96
CHAPTER FIVE: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
100
5.1 Introduction............................................................................................................100
Summary of Finding....................................................................................................100
Conclusions..................................................................................................................101
Recommendations........................................................................................................102
REFERENCES...........................................................................................................103
APPENDICES............................................................................................................111
APPENDIX 1: ETHICAL CLEARANCE...............................................................111
APPENDIX 2: APPROVAL TO COLLECT DATA..............................................113
APPENDIX 3: RESEARCH AUTHORIZATION.................................................114
APPENDIX 4: CONSENT FORM...........................................................................115
APPENDIX 4: DATA COLLECTION INSTRUMENT........................................117
APPENDIX 6: MAP OF MERU COUNTY...........................................................131
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LIST OF TABLES
Table 3:1 Public health facilities in Meru County.............................................................44
Table 4:1 Reliability Results..............................................................................................49
Table 4:2 Leadership Qualities..........................................................................................56
Table 4:3 Leadership Styles...............................................................................................59
Table 4:4 Leadership Competencies..................................................................................66
Table 4:5 Transformational Leadership Styles..................................................................81
Table 4:6 Transactional Leadership Styles........................................................................82
Table 4:7 Democratic Leadership Styles...........................................................................84
Table 4:8 Laissez-Faire / Passive/Avoidant Leadership Styles.........................................85
Table 4:9 Autocratic & dictatorship style..........................................................................86
Table 4:11 Perception of Leadership at Health Facility....................................................88
Table4:12 Perception of Leadership..................................................................................89
Table 4:13 Perception of Leadership.................................................................................90
Table4:14 Relationship between leadership on retention of human resources for health in
public health facilities........................................................................................................96
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LIST OF FIGURES
Figure 2:1 Centre for Creative Leadership Model.............................................................38
Figure 2:2 Porter’s Generic Value Chain...........................................................................39
Figure 2:1 Conceptual Framework....................................................................................40
Figure 4:1 Age bracket.......................................................................................................51
Figure 4:2 Gender..............................................................................................................52
Figure4:3 Length of Time in Position................................................................................53
Figure 4:4 Length of Time at the Station...........................................................................53
Figure4:5 Length of Time in Healthcare Service...............................................................54
Figure 4:6 Level of Education...........................................................................................55
Figure 4:7 Retention of Workers......................................................................................71
Figure 4:8 Number of employees......................................................................................73
Figure 4:9 Employees Left.................................................................................................74
Figure 4:10 Number of Left employees.............................................................................74
Figure 4:11 Current shortage.............................................................................................75
Figure 4:12 Age.................................................................................................................77
Figure 4:13 Gender............................................................................................................77
Figure4:14 Level of Education..........................................................................................78
Figure 4:15 Current position in this health facility............................................................79
Figure 4:16 Length in service............................................................................................80
Figure 4:17 Direct Supervisor............................................................................................81
Figure 4:18 Level of current staff turnover........................................................................95
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ABBREVIATIONS AND ACRONYMS
AIDS Acquired Immunity Deficiency Syndrome
DALYs Disability Adjusted Life Years
GOK Government of Kenya
HCW Health Care Workers
HIV Human Immune Virus
HIV Human Immunity deficiency Virus
MOH Ministry of Health
HRH Human Resources for Health
ICT information and communications technology
MOH Ministry of Health
WHO World Health Organization
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OPERATIONAL DEFINITION OF TERMS
Autocratic leadership: Refers to dictatorship method of running an organization.
Charisma:Rouses unquestioning steadfastness and dedication in the supporters without
respect to their own self-intrigue.
Democratic leadership:Alludes to the initiative, which considers the conclusions of
other individuals previously settling on a choice.
Employee Retention: A tacit or deliberate set of actions taken in order to retain
employees in an organization.
Health workforce retention Patterns: The praise will be used referring to the average
number of years health worker has been deployed to a particular working station.
Health-worker: These are individuals giving wellbeing administrations, for example,
specialists, medical caretakers, drug specialists, research facility experts and bolster
laborers.
Hospital effectiveness: Refers to the ability of the healthcare facilities to attain set
goals/objectives because of the leadership style.
Hospital efficiency: Refers to the running of the health facility by the administration with
minimum wastage/loss.
Hospital: Refers to healthcare institution where treatment of patients takes place.
Laissez faire leadership: Alludes to the initiative approach, which enables the supporters
to make, claim techniques and choice.
Leadership Competencies: Administration capabilities are the practices, learning,
aptitudes, and capacities that a man needs to give viable authority and decidedly influence
an association at a specific time.
Leadership style: Refers to the manner in which health care managers run the
organization.
Retention: refers to the ability of an health facility to retain itsDhealth workforce.
Staff turnover: An event that occurs when employees of healthcare facilities leave their
employers.
Transactional Leadership - perceives what the adherent needs and illuminates for the
devotee how these necessities will be satisfied in return for the supporter's acceptable
exertion and execution
Transformational Leadership- inspires supporters to accomplish more than they
initially anticipated that would do, by raising their level of mindfulness, by urging them to
rise above their own self-intrigue, or by adjusting their need levels.
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CHAPTER ONE:INTRODUCTION
1.1 Background of the Study
Wellbeing frameworks worldwide are coping with an evolving situation: epidemiologically,
regarding changing age structures, the effect of pandemics and the rise of new dangers;
politically, as far as changing recognitions about the part of the state and its connection with
the private area and common society; actually, as far as the developing mindfulness that
wellbeing frameworks are neglecting to convey – that again and again they are unjust,
backward and perilous, thus constitute one of the rate constraining components to
accomplishing better improvement results; institutionally, particularly in low-wage nations,
in dealing with an inexorably complex guide design, Yammarino, Dionne,
Chun&Dansereau, (2005).
The worldwide deficiency of wellbeing laborers is assessed to be around 2.3 million doctors,
attendants and birthing specialists, and more than 4 million wellbeing specialists generally
speaking (World Health Organization, 2009). Regional disparities exist between countries
with sub-Saharan Africa requiring an almost 140% increase in the health workforce in order
to overcome the crisis of the health workforce. A statistically significant relationship has
been established between health worker density and the burden of disease, expressed in
DALYs (Castillo-Laborde, 2011).
The Africa continent is currently facing severe human resource crisis in the health sector.
These human resource shortages have affected the delivery of quality and efficient health
services according to the World Health Report 2006. The overall human resource shortages
and distributional inequalities are well known and acknowledged in Kenya.
Kenya introduces an exceptional instance of Human Resources for Health (HRH) in sub-
Saharan Africa. While there is an outright deficiency of human services specialists, the
supplier populace proportion of 1.69/1000 (for all units of suppliers) is generally high for
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nations in the area. The most squeezing issue is the radically unequal appropriation of
specialists, by urban/rustic territories, by districts, and by level of care. Country dispensaries
have 20 percent fill rates of their nursing foundations, while region doctor's facilities have
120 percent fill rates. Around 25 percent of the HRH spending plan for the whole open area
is taken up by the two-referral healing facilities (Antonio, 2007).
Pioneers ought to receive a style that would set up and affirm their initiative expert by
methods for seeming skilled and dependable. Viable pioneers should manage individuals in
a way that enables them to add to the accomplishment of the gathering' general objective
(Mat, 2008). Workers will probably stay with an association on the off chance that they
conviction that their chiefs indicates intrigue and worry for them, in the event that they
comprehend what is anticipated from them, on the off chance that they are given a part that
fits their abilities and on the off chance that they get normal positive criticism and
acknowledgment. The nature of relationship a representative has with his or her prompt
administrators lengthens worker remain in an association (Ferreira, 2007 refered to in
Michael, 2008).
Gwavuya (2011) confirms that bumbling administration brings about poor representative
execution, high anxiety, low employment responsibility, low occupation fulfillment and
turnover expectation. Research directed on the territory of the Training industry inSouth
African demonstrated that administration style was the most conspicuous maintenance
factor in South Africa (Netswera, 2005). Sherman etal (2006) found in their examination
that greater part of the representatives in associations reviewed intended to stay with their
associations in any event for the following five years in light of the overall culture of
administration mind. Bite (2004) watched that authority conduct affects hierarchical duty
and turnover aim. Consequently writing shows that authority style is pivotal in staff
maintenance.
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1.2 Statement of the Problem
Medicinal services is an existence and passing business, even on the greatest days and in the
finest offices and the present social insurance laborer lack is making a frequently tiring
occupation much harder for human services officials. Enlisting and holding the general
population who keep social insurance associations running admirably is troublesome,
especially when interest for these experts so significantly surpasses supply and turnover is
wild. Studies have demonstrated that cost identified with specifically supplanting a
representative can be as high as 50– 60% of the worker's yearly pay, yet the aggregate cost
of turnover can reach as high as 90– 200% of the worker's yearly compensation (Shaw,
Duffy, Johnson, & Lockhart, 2005). These expenses incorporate hopeful perspectives, new
contract preparing, the selection representative's compensation, partition handling, work
blunders, lost deals, lessened assurance and various different expenses to the association and
influences hierarchical execution.
Maintenance of wellbeing workforce is especially basic in the social insurance field as the
requirement for laborers is tremendous and keeps on expanding.Meru County is
experiencing a chronic shortage of health workers (nurses and clinicians) and high staff
turnover. Hospitals are running with 205 staff instead of the required 600 (MeruSectoral
Committee on County Health Services, 2014). Further problems arise when employees leave
not only the organization but the health workforce itself to join other disciplines. In a sector
that is already suffering from shortages, employees are often difficult to replace. This
situation has compromised the quality of health services provided by the facilities. Worker
turnover is fundamentally expensive to bosses, both in money related and non-monetary
terms (Davison, Timo, Wang & Hollenbeck, (2010); Mukamel., 2009; O'Connell and Mei-
Chuan, 2007).
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In Meru County, a study linking the role of leadership on health workers retention has not
been done, hence knowledge gap on how leaders in the county can be enhanced to promote
worker retention. On the same note, no scientific information exists regarding the retention
patterns among different health workforce professionals in Meru County. With this gap, it is
difficult for decision makers to make informed directions regarding retentions. It is not
scientifically clear how leadership roles impact on retention of the health workforce in Meru
County hence making it is difficult to promote or select the most acceptable leadership style
for maximum retention of healthcare workers.
1.3 Study Objective
1.3.1 Overall Objective
The overall objective of this study is to determine the role of leadership on retention of
health workforce in publichealthcare facilities in Meru County, Kenya.
1.3.2 Specific Objectives
i. To determine the relationship between leadership competencies on the influence of
healthcare workers retention in public health facilities in Meru County
ii. To determine the influence of managers leadership styles on retention of health
workers in Meru County
iii. To determine the influence of managers leadership qualities on retention of health
workers in Meru County.
1.4 Research Hypothesis
Ho1. There is no significant relationship between leadership roles and retention patterns of
health care workers in public healthcare facilities in Meru County.
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1.5 Justification of the Study
Staff maintenance is a vital need of wellbeing framework organization. Research in business
and industry has demonstrated that authority styles are identified with maintenance, yet
documentation of this relationship is missing for staff in healing facilities.
1.6 Limitations of the Study
Some of the public healthcare workers were either on leave or off duty hence all of them did
not participate in the study. The sparsely populated area was a problem in the study.
To address these challenges the researcher wrote to the hospital administration quite in
advance about the importance of respondent’s taking part in the research so that
departmental heads may ensure the target population are persuaded to take part in this
research voluntarily and without asking for any reward.
1.7 Delimitations of the Study
This study used sample to reach an informed deduction as well as generalization. It’s well-
known that Sampling has some kind of limitation and to some extent biasness; this will be
mitigated by picking an adequate sample. Purposive sampling was used to identify the
healthcare facilities.
1.8 Significance of the study
This study will establish if leadership roles play any part on the retention of health workers
and their output performance. By understanding the link between leaders and the retention
of health care workers, the study will generate the basis for proposing best practices
necessary to enhance effective service delivery.
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This proposed study will help healing facility overseer and medical caretaker administrators
to grasp a compelling maintenance program as an orderly push to make and cultivate a
situation that urges staff to stay utilized by having arrangements, methods and practices set
up that address their assorted needs.The study will be useful to academicians since it will fill
the knowledge gap through extensive review of literature.
1.9 Assumptions of the Study
This study assumed that: the respondents would provide truthful information about the
questions in the questionnaires, and that factors exists within the health facilities leading to
health-care workers turnover.
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CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
This chapter reviews literature that is relevant to the study. Accordingly, the chapter
provides discussions on the theory of leadership, leadership characteristics, health workforce
retention in an organization, and organizational commitment
2.2Literature Review
a) The trait theory
The quality hypothesis is one of the efficient endeavors to think about administration
(Northouse,1997). It is one of the early endeavors to comprehend authority process that
spotlights on the pioneers individual characteristics. The most observable parts of this
hypothesis are that effective pioneers everywhere throughout the world and all through
history are conceived with innate qualities, for example, identity characteristics, social
attributes, capacity attributes and physical attributes. The groupings of initiative attributes
differ starting with one researcher then onto the next. Stodgil (1948) traces eight
characteristics in particular knowledge, readiness, understanding, obligation, activity,
constancy, self-assurance and amiability in his initially review. The administration attributes
and qualities have been obviously sorted by Jago (1982) and Daft (1999) by isolating them
into four gatherings in particular identity, social, capacity and physical characteristics (Mat,
2008).The hypothesis is exceptionally valuable to separate the pioneers from supporters,
compelling from ineffectual pioneers and the higher echelon from the lower echelon
pioneers.
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The hypothesis concentrates only on the part of the pioneer in administration and henceforth
has possessed the capacity to give a more profound and more complicated comprehension of
how the pioneer and his or her identity are identified with the authority procedure (Mat,
2008).Trait hypothesis is censured for the different reasons. The most generous issue is that
despite the fact that for a considerable length of time various explores on attribute
hypothesis have been led, there is no standard rundown of qualities acquainted which can be
utilized with characterize the administration adequacy. Second disappointment is the failure
of the quality hypothesis to constrain itself to a rundown of attributes. Thirdly, it is
connected to the supposition that a pioneer is conceived, if a man have certain qualities, he
is a pioneer. In this hypothesis the assurance of authority adequacy is exclusively subject to
the rundown of characteristic and not on the circumstance. This makes it hard to anticipate
initiative adequacy in light of the pre-characterized rundown of qualities in various
circumstances (Mat, 2008).
b)Theory X and Theory Y
Douglas McGregor's acclaimed refinement between Theory X and Theory Y brings out well
the two outrageous styles of administration; assignment arranged and relationship-oriented
management styles as cutting edge in the behavioral hypothesis (clarified beneath). In his
1960 book, "The Human Side of Enterprise" (McGraw-Hill), McGregor mentioned a
capable objective fact that administrative practice frequently communicates some profound
suppositions about the idea of people: Two contending speculations about human instinct,
he asserted, command the administrative idea world.
Hypothesis X says that the normal individual is sluggish and egotistical, needs aspiration,
hates change, and aches to be guided. The comparing administrative approach stresses add
up to control. Worker inspiration, it says, is about the dread and the torment. Hypothesis X
is censured for its contrary view about individuals and for its absolutist approach in
8
upholding authoritative guidelines (Voon, Ngui and Ayob, (2011). Hypothesis Y keeps up
that people are dynamic instead of latent shapers of themselves and of their condition. They
long to develop and accept accountability.
The most ideal approach to oversee them, at that point, is to oversee as meager as would be
prudent. Give them water and let them sprout, say the Y-sorts. Hypothesis Y compares with
relationship situated administration style. One would expect that selection of hypothesis Y
would help worker maintenance; nonetheless, other behavioral speculations (as clarified
beneath) will reveal to us that it is not generally the situation.
c) The Behavioral Theory
The behavioral hypothesis accept that pioneers can be made as opposed to conceived and
that initiative depends on quantifiable and learnable conduct. Behavioral hypotheses of
authority don't look for in-conceived attributes or capacities yet rather they take a gander at
what pioneers really do. Not at all like the attribute hypothesis, the behavioral hypothesis
accept that initiative capacity can be adapted instead of being inalienable. The hypothesis
recognizes two practices that pioneers may display; the undertaking focused conduct and
relationship-arranged conduct. In current circumstances, relationship-situated conduct is by
all accounts the favored style.
2.3 Health managers leadership competencies of health care managers and retention of
health workers
While skills are a present day tradition in preparing and initiative advancement, numerous
ventures have discovered abilities valuable for deciding if a competitor would be a proper
match for a particular position, and additionally distinguishing potential regions for
development and improvement of current representatives. The cutting edge utilization of
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competency-based HR can be followed back to 1973, when McCleland proposed an
arrangement of capabilities to be utilized as pointers of execution (Boyatzis, 2008). Today,
businesses running from social insurance to designing to government have utilized center
competency models to control vital change programs that address authority and authoritative
culture (Calhoun et al., 2008).
The term administration capabilities is utilized to portray the arrangement of practices,
information, aptitudes, and capacities that a man needs to give initiative and decidedly affect
an association at a specific time (McNamara, 2003). Stahl and Bjorkman (2006)
characterized authority abilities as an arrangement of regular individual qualities to be found
in pioneers, which are required for exceptional execution (p. 60). Spencer and Spencer
(1993) recommended that abilities are examples of feeling that underscore practices, making
a long haul affect. Drawing from a human studies and HR foundation, Zwell (2000) clarified
that the act of behavioral skills can be utilized to build up a typical, binding together
establishment whereupon corporate culture, procuring practices, and worker advancement
procedures might be produced.
Boyatzis (2008) considered skills to be a behavioral way to deal with passionate, social, and
psychological knowledge. Enthusiastic knowledge capabilities draw on such ideas as
mindfulness and passionate poise. Social knowledge capabilities show in social mindfulness
and connections, including cooperation and sympathy. Intellectual insight capabilities
incorporate frameworks considering and design acknowledgment. A fourth measurement,
social insight, was presented by Chin and Gaynier (2006), to convey consideration regarding
binding together factors that undergird associations and individuals. The creators stated that
in the worldwide commercial center, social progression are basic to hierarchical change and
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administration achievement. For an association, culture incorporates shared esteems and
controlling standards, and altogether impacts an association's gainfulness and general
execution.
Intagliata, Ulrich, and Smallwood (2000) underscored the down to earth parts of skills in
their depiction of an authority mark. The creators expressed that skills are an essential
device for authority improvement since they give guidance to workers, are quantifiable, can
be learned, and may help coordinate administration rehearses. By and large, the abilities
may help make an initiative brand and separate the association's nature of administration.
Inside the corporate commercial center, such qualifications have money related esteem, as
an Ernst and Young report (as refered to in Intagliata, Ulrich, and Smallwood, 2000)
demonstrated that 30 – 40% of financial specialist choices might be connected to nature of
administration (p. 13). In advanced education, such financial specialists might be
contributors, lawmakers, or understudies attempting to figure out where to consume their
assets. Hernez-Broome and Hughes (2004) brought up that authority improvement in
associations happens in a workplace through such techniques as preparing projects, training
and coaching, activity learning, and advancement assignments. The educational program
used to manage this advancement depend on the association's administration skills.
2.3.1 Level of education
Instructive achievement alludes to the most elevated amount of tutoring that a man has come
to. While formal instruction, for example, preparing at schools and colleges might be a
viable intends to achieve the future workforce, the fast change and improvements on the
planet accentuate the requirement for deep rooted learning (Kirsch and Lennon, 2005).
Regardless, training can be a vital intends to create in any event essential administration and
administration abilities (Veenhof 2005; Mioduser, Nachmias, Tubin, and Forkosh-Baruch,
11
2003). As per the [BECTA], (2009) one investigation in Britain found that individuals with
more training have higher authority abilities, however proposes that more taught individuals
have a tendency to be in initiative positions.
Some restoratively prepared wellbeing administrations supervisors work in ranges, for
example, nursing or non-intrusive treatment, and their obligations may include tolerant care,
and in addition administration capacities. Most are utilized by clinics, however some
wellbeing administrations directors work for specialists' workplaces, nursing care offices
and human services administration associations. Instructive prerequisites are ordinarily a
graduate degree in wellbeing sciences, business organization or a related field, albeit some
may have just a four year certification. Candidates with graduate degrees may enter the
occupation showcase at the supervisory level; be that as it may, candidates with a four year
college education may begin as clerical specialists and work their way up while picking up
at work preparing.
2.3.2 Professional training
The present medicinal services scene is a dynamic, erratic ocean of administrative and
financial change. Social insurance pioneers, to be specific those in managerial and
administration parts, require an extensive variety of operational, social, and investigative
aptitudes to successfully do their duties. Medicinal services directors' capacities to carry out
their occupations well, specifically influence the quality and accessibility of reasonable
social insurance.
The present dynamic social insurance scene calls for very taught and propelled heads who
keep up bleeding edge data framework aptitudes and administrative skill as they supervise
immense human services operations. A solid business introduction, combined with sharp
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initiative and relational abilities are basic for the present social insurance chairman. Certain
operational aptitudes are vital to a viable pioneer. Human services directors are regularly
required to keep up and create proficient principles, systems, and approaches for different
institutional exercises. These human services pioneers are likewise in charge of creating and
growing projects for logical research, preventive medication, medicinal and professional
recovery, and group wellbeing and welfare.
Troughs in social insurance assume an imperative part in guaranteeing that there is an expert
lead with obvious specialist, who is available and can go about as a backer for attendants
and birthing assistants inside a wellbeing administration at the official and board level
(Duffield et al., 2007). The nonappearance of expert authority through to the official level
can bring about a debilitated workforce with expanded staff turnover (Duffield et al., 2007;
Duffield et al, 2011).
There is specialist need to finding a way to guarantee that there is proceeded with initiative
expert improvement for every one of those in authority position and showing others howits
done, the administrators make will make a culture which is foundational in making a
workplace of joint effort, cooperation, and shared administration (Clavelle et al., 2012;
Hayes et.al, 2012; Laschinger et.al, 1999; and Upenieks, 2003). The official can give adjust
inside the official group and for board basic leadership between the arrangements of
coordinated wellbeing customer mind, conveying key wellbeing administration focuses of
budgetary respectability and asset venture arranging. Also, the official can drive a
framework wide approach in help of wellbeing shopper mind through deliberately checking
and keeping up more productive and successful nursing and maternity care mind pair with
adding to the improvement and execution of hierarchical methodologies to accomplish
scratch benefit execution targets (Stichler, 2006).
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2.3.3 Management level in the organization
Great authority is imperative for the accomplishment of any association. In a social
insurance association, great administration is something other than imperative; it is totally
basic to the association's prosperity. Administration in associations is an intrinsically
multilevel marvel (Dansereau et al., 1984; Yammarinoet al., 2005). Authoritative viability
relies on composed administration being instituted from pioneers dwelling inside different
various leveled levels, whose initiative shapes significant individual-, group, unit-, and
hierarchical level results. Regardless of this reality, explore on authority frequently appears
to be disengaged (Zaccaro and Klimoski, 2001) owing at any rate to a limited extent to
isolate disciplinary gatherings controlling hypothesis and research on initiative at various
levels; for instance, hierarchical level administration inquire about is for the most part the
region of business researchers while bring down level administrative administration look
into has a solid establishing in brain science.
Numerous initiative scholars have expressly recognized that authority needs are reliant on
the pioneer's level inside the association (Day and Lord, 1988; Hunt, 1991; Hunt and Ropo,
1995; Jacobs and Jaques, 1987; Katz, 1955; Katz and Kahn, 1978; Zaccaro, 1996; Zaccaro
and Klimoski, 2001). Albeit much administration look into grounded in brain science has
had a tendency to inspect rich progression of initiative, the discoveries generally apply to
pioneers at bring down levels of the authoritative order. At the flip side of the range is
explore directed in key administration, which yields an arrangement of discoveries with
respect to attributes of best level pioneers and their example of correspondence to
hierarchical methodologies and results (Hambrick and Mason, 1984). Jacobs and McGee
(2001) separate three general levels of administration, which relate to the since a long time
ago perceived three-layered authoritative plan. At the base, administration includes
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supervision where pioneers contract and fire and assign undertakings. The following layer
up is center administration where pioneers set up operational objectives and facilitate the
exertion required to meet these targets. The best level administration layer is the key
pinnacle of the association which sets up a dream and sets wide destinations for the general
association.
Zaccaro (1996) made the point that pioneers at various authoritative levels authorize similar
capacities: bearing setting, limit spreading over, and operational support, however do as
such in an unexpected way. The distinction between course setting at the best versus the
base of the association lives in the time skyline. At the base of the association, a pioneer
may get ready for a 3-month time skyline while at the CEO level, the skyline incorporates
getting ready for years and perhaps decades ahead (Jacobs and McGee, 2001).
With limit spreading over, the distinction rests in the idea of the limit the pioneer is
traversing. At bring down levels of the association, the pioneer is limit spreading over
between his/her unit and different units inside to the association; on the other hand, at larger
amounts of the association, pioneers progressively traverse limits that connection his/her
unit to elements outside the hierarchical limit, (Zaccaro and Klimoski, 2001). Operational
support and coordination varies in how much pioneer communication is immediate versus
circuitous. While pioneers at all hierarchical levels encourage coordination, at bring down
levels the coordinative conduct is immediate, though at larger amounts it includes
progressively aberrant activities, for example, the foundation of working systems to
routinize ideal coordinative examples. Significantly, building an entire and valuable
investigation of authority includes examining these administration forms at these three and
other important (e.g., key cooperations) authoritative levels.
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In the ebb and flow survey we analyze the degree to which past research on authority
educates learning about best, center, and lower level initiative procedures. The thought is
not to contend that initiative at any one level is pretty much critical than administration
happening at another level, but instead to present that if authority hypothesis holds that
behavioral as well as competency needs change at various hierarchical levels (Zaccaro and
Klimoski, 2001) and the results of importance likewise change, at that point it would be a
significant practice for authoritative researchers to vivaciously examine administration
elements at all levels.
Social insurance frameworks are made out of various expert gatherings, offices, and fortes
with many-sided, nonlinear communications between them; the unpredictability of such
frameworks is regularly unparalleled because of imperatives identifying with various
sickness zones, multidirectional objectives, and multidisciplinary staff. Inside expansive
associations, for example, medicinal services frameworks, the various gatherings with
related subcultures may bolster or be in struggle with each other. Initiative needs to profit by
the assorted variety inside the association all in all and effectively use assets when planning
administration forms, while urging faculty to work towards shared objectives. Various
administration methodologies can be adjusted to the human services setting to improve
administration in this exceedingly complex condition (Jossey-Bass; 2003).
The essential contrasts between levels of directors are the level of expert and the extent of
obligation and authoritative movement at each level. For instance, top-level directors, for
example, nursing managers have expert over and obligation regarding the whole association.
Center level directors, for example, division heads and heads of administrations have expert
over and obligation regarding a particular section, as opposed to the association all in all and
16
go about as a contact between top-level administrators and first level supervisors. To begin
with line directors, who for the most part answer to center level chiefs have specialist over
and are in charge of administering particular work for a specific gathering of works.
2.4 Managers leadership styles and retention of health workers
Initiative is life blood of any association and its significance can't be thought little of. Many
creators have considered this wonder, yet there is no cognizant meaning of what initiative is,
no prevailing worldview for contemplating it, and little assention with respect to the best
procedures for creating and practicing it (Bennis, 2009; Hackman and Wageman; 2010
Vroom and Jago, 2007). Omolayole (2006) sees authority as that sort of course, which a
man can provide for a gathering of individuals under him such that these will impact the
conduct of another individual, or gathering. Ngodo (2008) sees authority to be a
complementary procedure of social impact, in which pioneers and subordinates impact each
other keeping in mind the end goal to accomplish authoritative objectives. Administration
style is seen as the mix of qualities, attributes, abilities and practices that pioneers utilize
while communicating with their subordinates (Marturano and Gosling, 2008, Jeremy,
Melinde& Ciller, (2011). Flippo and Musinger (2010) consider initiative to be an example
of administrative conduct intended to coordinate individual or hierarchical intrigue and
impact, in quest for a few destinations.
Fiedler (2008) hypothesizes that initiative style alludes to a sort of relationship whereby
somebody utilizes his ways and strategies to influence many individuals to cooperate for a
typical errand. In current authority hypotheses, five initiative styles have been exhibited,
including (i) alluring administration, (ii) value-based administration, (iii) transformational
initiative, (iv) visionary authority, and (v) culture-based initiative (Yukl, 2000).
17
Tannenbanum and Schmidt (2000) additionally distinguish four unique sorts of pioneers
which have been most generally acknowledged and utilized. These authority styles, which
base on McGregor's Theory 'X and Y' suspicions, are majority rule, imperious, tyrannical,
and free enterprise initiative styles. The following is a short examination of some normal
initiative style measurements recorded above and their potential effect on a gathering and in
addition their relative convenience.
2.4.1 Autocratic Leadership Style
Organization is life blood of any affiliation and its noteworthiness can't be had a poor
opinion of. Numerous makers have considered this wonder, however there is no perceptive
importance of what organization is, no mind-boggling perspective for pondering it, and
small comprehension regarding the best procedures for making and rehearsing it (Bennis,
2009; Hackman and Wageman, 2010 Vroom and Jago, 2007). Omolayole (2006) considers
specialist to be that kind of bearing, which a man can accommodate a social affair of people
under him with the end goal that these will affect the lead of another individual, or get-
together. Ngodo (2008) sees specialist to be a relative method of social effect, in which
pioneers and subordinates influeThis activity style is every now and again assigned the built
up approach (Swarup, 2013). It is a style of organization where a manager is the most
proficient component, the basic boss and master (Gordon, 2013). This style of specialist
relies upon the standard begin that pioneers are extraordinary chairmen who direct and
control their family. Those supporters (laborers) are conscious subordinates who take after
solicitations. Gordon (2013) that delegates under totalitarian activity style are depended
upon to take after the solicitations of their boss paying little mind to the likelihood that they
don't agree or don't get any elucidation supports this position. She fought that to move
delegates, boss using oppressive activity styles as often as possible use a course of action of
prizes and trains that are exceedingly sorted out.
18
Zervas and David (2013) set that an authoritarian pioneer accomplishes closes through
giving a sensible, persuading vision, sees to it that the vision is fused with key organizing,
and that it guides movement all through the affiliation. They push that tyrannical pioneers
give clear direction, screen progress eagerly, and influence subordinates in regards to the
position of organization. Gordon (2013) communicated that relationship with an oppressive
style of specialist have cases of delegate non-participation and shockingly high turnover.
She kept up that agents' issues with dictatorial expert consolidate managers don't place stock
in their specialists, the way that chiefs frequently use teach or hazard to motivate laborers,
and how delegates' information is all around not regarded. She also centered around that
authoritarian specialist much of the time adversely influences laborers' confirmation.
Despite this perceived drawbacks of authoritarian activity style, Swarup (2013) battled that
absolutist expert is not all dreadful. He sets that periodically it is the best style to apply in
conditions when: new and untrained delegates who may not be acquainted with the
endeavors to perform or are confronted with issue of which system to take after, effective
supervision can be given quite recently through point by point solicitations and bearings, in
conditions where agents are reluctant to some other specialist style, there are high-volume
creation needs on regular calendar, there is time restriction to settle on a decision, a heads'
vitality is tried by a laborer, the workplace is insufficiently managed, and when work ought
to be encouraged with another office or affiliation. He nevertheless, recommended that
domineering expert style should not be used when: agents wind up obviously stressed,
horrendous and furious, laborers plan to have their evaluations heard, delegates begin
dependent upon their overseers to settle on each one of their decisions, and there is low
illustrative certainty, high turnover, non-participation, and work stoppage.
19
nce each other in order to fulfill definitive destinations. Activity style is viewed as the mix
of characteristics, qualities, capacities and practices that pioneers use while coordinating
with their subordinates (Marturano and Gosling, 2008, Jeremy et al., 2011). Flippo and
Musinger (2010) view expert for instance of authoritative lead planned to join individual or
various leveled interest and effect, in journey for a couple of objectives.
Fiedler (2008) estimates that organization style implies a kind of relationship whereby some
individual uses his ways and methodologies to impact numerous people to collaborate for a
commonplace endeavor. In current expert theories, five activity styles have been presented,
including (i) beguiling organization, (ii) esteem based activity, (iii) transformational
organization, (iv) visionary activity, and (v) culture-based activity (Yukl, 2000).
Tannenbanum and Schmidt (2000) also perceive four exceptional sorts of pioneers which
have been most comprehensively recognized and used. These activity styles, which base on
McGregor's Theory 'X and Y' doubts, are fair, dictatorial, overbearing, and free endeavor
specialist styles. The accompanying is a brief examination of some essential activity style
estimations recorded above and their potential impact on a social affair and furthermore
their relative esteem.
2.4.2 Democratic Leadership
Weihrich and Koontz (2009) allude to this style of administration as participative. The
pioneer counsels with supporters/subordinate on proposed exercises and choice. The pioneer
gets engaged with approach definition yet does not overwhelm bunch activity, Lall and Lall
(2000). The adherents are urged to take an interest and no activity without their comfort may
occur or the choice may just be taken after counsel. Muzaasi, (2000) features the
cooperation of the gathering and the pioneer in detailing of arrangements that fills in as rules
20
for authoritative operations. Choices are made after discussion with different individuals in
the association. Pioneer infers his power and power from his supporters. People are made to
feel essential and a vital part of the association. People openly offer their uncommon
aptitudes and gifts and contribute towards the accomplishment of the association. Pioneers
delegates duty to staff however they may have a last say.
In spite of the advantages related with vote based administration style, it is as yet laden with
a few entanglements. Donna (2011) focused on that the law based authority is set apart by a
few downsides that must be overcome to guarantee its adequacy in the association. He
brought up five fundamental difficulties of the vote based initiative style to include:
competency, emergencies, agreement, pseudo-support, and adherence. He additionally
presumed that conquering these five negatives of the popularity based authority style will
enable associations to completely profit by the upsides of this administration style, for
example, higher representative execution, fulfillment and better degrees of consistency.
This is on the grounds that a workplace with vote based administration style makes open
doors for representatives' strengthening, inventiveness, activity, investment, profession
development and advancement and progression, and furthermore accommodates a protected
future with the association. These are major inspiration factors that are constantly clamored
for by enabled workers, especially in this globalized and information based economy.
2.4.3 Bureaucratic Leadership Style
In this style of initiative, the chief oversees "by the book". It requires add up to consistence
to strategies and standards. On the off chance that the standards and controls don't cover a
particular circumstance, the bureaucratic pioneer seeks the administrator for direction
(Zervas and David, 2013). Michael (2010) contends that in bureaucratic initiative, the
21
strategies drive execution, methodology, destinations and results in the association. He
focuses advance that since bureaucratic pioneers are normally dedicated to methodology and
procedures rather than individuals (representatives), they frequently seem unapproachable
and are exceedingly loath to change. Swarup (2013) brought up that bureaucratic authority
style can be successful when: representatives are performing routine errands again and
again, workers need to comprehend certain norms or systems, workers are working with
hazardous or sensitive hardware that requires a distinct arrangement of methods to work,
wellbeing or security preparing is being directed, and representatives are performing
assignments that require taking care of money.
The superseding ramifications of bureaucratic style of administration in association is that it
overlooks the advantages of the pioneer to propel and create representatives, since
approaches are basically insufficient to the assignment of inspiring and building up
representatives' dedication in working environment. Arrangements are not in themselves
ruinous, but rather non-cutting edge and neglectfully created and aimlessly actualized
strategy can de-rouse representatives and baffle wanted results. This may block execution
and actuate representatives' turnover in the association.
2.4.4 Charismatic Leadership Style
The alluring administration style turned into a theme of extraordinary enthusiasm after a
revival of the logical field of authority in the late 1980s and mid 1990s, which incorporated
an expansion in distributions and the elaboration of initiative (Conger and Hunt, 1999). The
idea is gotten from the Greek word mystique, which signifies "supernaturally enlivened
blessing" (Stephen, 2013).
22
Appealing activity style is the specialist style that has his effect springing generally from the
personality of the pioneer (Eze, 2010). Analysts have fought that charming specialist can be
described by unmistakable practices that occur in three dynamic stages: the primary stage is
assessing the earth. In this stage, the attractive pioneer sees the necessities of the
subordinates and discusses their failure with the current situation. The second stage is the
time when the enchanting pioneer characterizes a fantasy and confers this vision suitably to
the lovers (delegates). The third stage is the execution of the vision which requires that the
pioneer exhibits in a risky and surprising way to deal with secure the devotion of the
subordinates, for instance, promptly introducing themselves to conditions with uncertain
outcomes and going for broke (Ehrhart and Klein, 2001).
In the perspective of Jaepil (2006), magnetic authority expect three center segments:
imagining, compassion, and strengthening. He contended that a charming pioneer's
imagining conduct impacts the devotees (representatives) requirement for accomplishment,
the pioneer's empathic conduct fortifies the adherents' requirement for connection, and the
supporters' requirement for control is upgraded by an appealling pioneer's strengthening
hones. Michael (2010) places that a charming authority gives a prolific ground to
imagination and inspiration, and it is frequently exceedingly motivational.Zervas and David
(2013) expressed that in a charming administration style, initiative is accomplished through
setting a case, as opposed to through guideline or purposeful staff improvement, foundation
of elevated expectations, and through give energy. They contended that individuals take
after an appealling pioneer in light of what they trust the pioneer can do, not by his initiative
ability.
23
Researchers have given clarification to the potential liabilities of alluring initiative by
drawing a qualification amongst customized and mingled charming administration (House
and Howell, 1992; Howell and Shamir, 2005). This refinement is drawn in light of the
perception that a few pioneers respond to hierarchical issues as far as their own particular
needs as opposed to those of the association, and may subsequently participate in activities,
which have unfavorable results for the association (O’Connor, Mumford, Clifton, Gessner,
and Connelly, (1995); Stephen, 2013). Customized appealing administration is exploitative,
non-libertarian, and cocky. Then again, mingled alluring authority will probably be
engaging to devotees, non-exploitative, and roused by authoritative instead of individual
needs, (Stephen, 2013).
2.4.5 Laissez-Faire Leadership Style
Muzaasi, (2000) affirm that Laissez-faire is a French word meaning “let people do what they
wish’. There are no rulers and leadership grant complete freedom to group decision. This
style gives the subordinates a high degree of independence in their operations. Subordinates
set their goals and means of achieving those (Weihrich& Koontz (2009). The followers are
only aided by supplying them with the required information. The leaders in this case act as
the contact person with the group’s external environment. Very little power is used.
Weihrich and Koontz (2009) also refer to it as a free rein. Okumbe (2000) outline Laissez-
faire as one where the leader tends to avoid power and authority. Members establish goals
and means of achieving progress to success. Chances of anarchy and chaos are high since
the leadership does not guide people’s activities. (Muzaasi, 2000).Miskel and Hoy (2000)
observes that this leadership avoids expressing their views or taking action on important
issues. The leadership ignores responsibility, provides no feedback and allows authority to
remain dormant. This style is regarded as the least effective, which represent absence of
avoidance of leadership. Uris, (2000) concluded in his research that members in Laissez-
24
faire group progressed haphazardly and took more time in arguments and discussion mostly
on purely personal basis.
The free enterprise administration style has been scrutinized for its negative impact in the
association. Alan (2013) contended that the initiative style can be harming if the colleagues
don't deal with their opportunity well or in the event that they don't have the learning,
abilities, or inspiration to do their work successfully. Ronald (2011) contended that free
enterprise initiative style can prompt political agitation, disorder, and wastefulness.
Regardless of these distinguished drawbacks of free enterprise authority style; Alan (2013)
has likewise brandished some positive part of the initiative style. He sets that the principle
advantage of free enterprise initiative style is that it gives colleagues much self-governance;
it can prompt high occupation fulfillment and expanded efficiency in the association. This
proposes if workers under free enterprise administration feel fulfilled on their occupation, it
benefits that such an authority style could enhance representatives' execution and upgrade
their maintenance in the association.
2.4.6 Situational Leadership Style
Paul Hersey and Kenneth Blanchard first built up the idea of situational authority in 1969
(Richard, 2013). The hypothesis was first presented as "life cycle" hypothesis of initiative
and later renamed situational administration hypothesis in 1972 (Mwai, 2011). In 1985,
Blanchard re-imagined the model and it was named the situational authority 11(SL11) show
(Qin, 2011). The situational way to deal with administration depends on the supposition that
each example of initiative is extraordinary and in this way requires an interesting mix of
authority, supporters, and initiative circumstance (Richard, 2013). The collaboration in
situational initiative is normally communicated in an equation: SL=F (L, F, and S), where
25
SL is effective administration, F remains for capacity of; and L, F, S, are separately the
pioneer, the devotee, and the circumstance. At the end of the day, this recipe expresses that a
fruitful authority is a component of a pioneer, devotee and circumstance that are suitable for
each other (Richard, 2011).
The researchers of situational activity style set that a pioneer needs to fit his organization to
the individual essential of a condition. This infers the pioneer's direct should be reliant upon
the situation (Peng-Hsian, Hsin, and Thun-Yun, 2008). Rotimi (2013) cleared up that the
speculation of situational activity attests that there is no one style of specialist that identifies
with all given workplace condition. Or, on the other hand perhaps, effective pioneers change
their organization styles to fit the situation. Along these lines a pioneer's style changes with
both the conditions they are faced with and the condition that they are in.
It holds that boss must apply assorted activity styles depending upon the distinctive
specialist conditions that they go up against (Rotimi, 2013). This in like manner
recommends the situational activity style empowers pioneers to survey the necessities of
specific situational challenges and apply the most appropriate organization style to address
them. In the viewpoints of Peng-Hsian et al. (2008), the situational activity display gives
that a convincing pioneer must hurry to modify their power style to the present needs of the
followers. They extend that a convincing pioneer should have the ability to watch and stamp
the levels of planning in his enthusiasts and subsequently modify these evolving levels. This
proposes a pioneer must perceive when and how to use the best possible style to help and
influence agents in the workplace.
A basic survey of the situational initiative style recommends the suggestion that it offers
help and inspiring condition for representatives in the association in light of their needs;
26
subsequently applying the authority approach can assemble assurance among workers and
make a profitable domain that will alleviate representative turnover.
2.4.7 Transactional Leadership Style
The transformational initiative is one of the most up to date ways to deal with administration
and is synonymous with proactive usage of progress (affecting), motivation, inspiration of
supporters, comprehension and adjusting to the requirements of adherents (singular
thought), and scholarly incitement that prompts advancement (Bass &Avolio 2000). The
pioneer engages devotees through a mutual vision, trust and regular esteems, motivating
their impact crosswise over systems. By differentiate value-based model of initiative offers
motivating force based trade between the pioneer and adherent as an end-result of improved
execution. This approach is errand engaged, in light of order, sidesteps the necessity to
connect with individual and concerns upkeep and observing a previous administration,
having an operational instead of a vital core interest.
Transformational administration is much the same as charming or visionary initiative
(Howell, 2001). Transformational pioneers move and inspire supporters (House RJ (2001) in
ways that go past trades and rewards. A value-based initiative style is fitting in numerous
settings and may bolster adherence to hone measures however not really receptiveness to
development. Naturally, value-based pioneers stay away from many-sided quality and
endeavor to guarantee unmistakable, separated control to confine the risk and weakness of
vulnerability (McAdam, 2003) and, through productivity, are in threat of delivering
unremarkableness and choking out development and imagination when real strides forward
are required by the association (Fairholm, 2000). Lewis, Goodman and Fandit (2001) give
cases of once unmistakable and all around regarded value-based sort CEOs who surrendered
from their employments James Robinson from American Express, John Akers from IBM,
27
and Eckhard Pfeiffer from Compaq, to give some examples. Huge numbers of these CEOs
fizzled in light of the fact that their administration style was essentially not fitting for the
quickly changing and profoundly powerful business condition.
A transformational administration style makes a dream and moves subordinates to endeavor
past required desires, though value-based initiative concentrates more on extraneous
inspiration for the execution of occupation undertakings (Jung, (2001). They raise their
devotees' attention to hierarchical issues and their outcomes, they make a dream of what the
association ought to be, assemble sense of duty regarding that vision all through the
association, and encourage authoritative changes that help the vision (Certon, 2000).
Transformational initiative is not quite the same as value-based pioneers who portray
various associations who are attempting to adapt to the present quick ecological changes. As
indicated by Gibson (1998), transformational authority that is basic in confronting the
present difficulties won't be substance to kick back and let the journey control do the
driving. These pioneers will be looking forward, filtering the scene, viewing the opposition,
spotting rising patterns and new open doors, abstaining from looming emergency. They will
be voyagers, swashbucklers, pioneers. Lewis, Goodman and Fandt (2001), clarifies that a
few associations have exploited changes in the earth. Starbucks as an espresso vendor, Sony
as the world's biggest supplier of electronic items, and Dell Computer as the supplier of high
quality, low cost PC hardware. Each of these organizations has made progress by
proactively tending to changing economic situations.
Value-based pioneers are aces at controlling assets, strategies and schedules (Darling, 2002).
They are overseers of the present state of affairs (Warburton, 2007) who think as far as
intelligibility, with an attention on control and responsibility (Bennis, 2010). These pioneers
28
identify with different on-screen characters in part terms and support unwaveringness,
similarity, coordination and cooperation (Fairholm, 2000). They incline toward security and
are compelling in circumstances where they can coordinate the coveted conduct, control
deviation from set standards, and rebuff stubbornness (Zemke, 2009).
Researchers have contended that value-based initiative style acquires a few advantages and
drawbacks the association. They place that the advantages related with value-based authority
include: the administration style clears up representatives' parts and obligations, value-based
initiative judges colleagues on execution, and representatives who are roused by outer prizes
incorporating remuneration regularly flourish in the work environment that is overseen by
the value-based pioneer. The drawback of value-based initiative is that colleagues can make
a little to enhance their showing with regards to fulfillment. The researchers push this can
smother workers' confidence and prompt turnover in the association (Alan, 2013; Zervas and
David, 2013).
2.4.8 Transformational Leadership Style
As per Miskel and Hoy (2008) transformational initiative are proactive, raises the
mindfulness levels of adherents on motivational aggregate interests and enable supporters to
accomplish curiously elite results. Bass and Riggio (2009) in Miskel and Hoy (2008)
thought of a hypothesis of four 1s, glorified impact, moving inspiration, scholarly incitement
and individualized thought. Admired impact is realized by the immense conviction on
essential issues by the pioneer, high moral and good standard set, sharing of dangers,
defining and achieving objectives and also considering the necessities of others over claim.
Consequently, the pioneer is appreciated, regarded and trusted by the supporters.
29
Motivation inspiration depends on the supporter's conviction that the association's issues can
be settled as expressed by Atwater and Bass (2004) in Mikel and Hoy (2008). The
adherentsareenergized by anticipating an alluring and hopeful vision for the association. The
adherents are made to conviction that the vision is feasible. In this manner, camaraderie,
eagerness, positive thinking, objective responsibility and a mutual vision emerge. Atwater
and Bass (2009) in Miskel and Hoy (2008) additionally battle that scholarly incitement is
sustained through the way of life of addressing old suppositions, conventions and
convictions, reframing issues and moving toward old circumstances in new ways.Followers
are tested to do things imaginatively and in a creative way.
Individualized thought spins round the issue of the requirements and quality of others as
Atwater and Bass (2010) in Miskel and Hoy (2008) legislative issues. Along these lines,
supporters create to effectively larger amount of potential while assuming liability for their
own particular advancement Avolio (2010) in Miskel and Hoy (2008). New learning open
doors are made in a steady atmosphere while in the meantime perceiving singular contrasts.
Research discoveries directed from Mid 1980s propose that change authority speak to the
perfect pioneer. Avolio (2010) in Miskel and Hoy battle that glorified impact and uplifting
authority are the best and fulfilling. Along these lines great administration ought to create
individuals and construct groups as recommended by Bass (2009) in Miskel and Hoy
(2008).
2.5 Managers leadership qualities and retention of health workers
The conveyance of fruitful wellbeing and social care administrations depends on powerful
administration and solid initiative. More than 50 qualities have been distinguished that are
critical to extraordinary pioneers. Be that as it may, there are seven administration qualities
30
that appear to emerge as being more critical than the others.This includes being Visionary,
Courageous, Integrity, Humility, Strategic Planning, Focus and Cooperation.
2.5.1 Visionary
Visionary authority is the capacity to make and express a practical, feasible, and appealing
vision without bounds for associations, which develop ceaselessly. Visionary pioneers ought
to make motivating and imaginative dreams for their associations rendering them sound
according to the general population in the association in the meantime. Visionary pioneers
have three qualities, which are identified with their viability. To start with, is the capacity to
clarify and express the vision to the others. Second, is to express the vision not simply
verbally but rather through the pioneer's conduct. Third, is to convey the vision to various
authority settings. For instance, the vision of the association should speak to workers in
various divisions (Robbins, 1998).
Awesome pioneers have vision. They can see into what's to come. They have an
unmistakable, energizing thought of where they are going and what they are attempting to
finish and are amazing at key arranging. This quality isolates them from chiefs. Having an
unmistakable vision transforms the person into an extraordinary sort of individual. This
nature of vision changes a "value-based director" into a "transformational pioneer." While a
chief takes care of business, incredible pioneers take advantage of the feelings of their
workers.
Without clear correspondence, your workers won't comprehend your central goal,
objectives, and vision. Representatives need to progress in the direction of something they
have confidence in, so it's essential they comprehend that they are moving in the direction of
31
similar objectives you are. Correspondence ought to likewise be predictable in setting up
work desires, giving useful input, and in preparing new representatives. With extraordinary
correspondence, your representatives will know precisely what they are really going after,
will depend on you, and will give their best exertion for you.
2.5.2 Sense of humor, diplomatic and humble, admits mistakes and learns from
others
In spite of the fact that not a necessity, a comical inclination goes far in administration. It
makes a positive workplace and improves the sentiment kinship. Warren Buffett, for
instance, once stated, "I purchase costly suits. They simply look shabby on me." Leader's
one of a kind identity and comical inclination indicates representatives that they are more
than a pioneer, and that they are not a machine, which urges them to feel great around them.
Lowliness doesn't imply that you're frail or uncertain of yourself. It implies that you have
the fearlessness and mindfulness to perceive the estimation of others without feeling
debilitated. It implies that you will concede you could not be right, that you remember you
might not have every one of the appropriate responses. Furthermore, it implies that you
acknowledge a job well done.
2.6 The impact of leadership on employee retention
Taunton, Boyle, Woods, Hansen and Bott (2010) attempted to follow the impacts of chief
authority attributes on staff enrolled nurture maintenance. They found that supervisor
thought of staff specifically influenced maintenance. Results from another investigation
uncover that directors with initiative styles that look for and esteem commitments from
staff, advance an atmosphere in which data is shared adequately, advance basic leadership at
the staff nurture level, apply position power and impact coordination of work, give a milieu
that keeps up a steady unit of medical attendants (Tauntonet al. 2010). Testing the
transformational initiative hypothesis, McDaniel and Wolf (2000) found that scholarly
32
incitement, moxy and singular thought are parts of administration, which upgrade
maintenance and staff fulfillment. The creators recommend that transformational factors are
like authority qualities depicted in "magnet" healing facilities.
One of the basic parts of administration is to make a workplace that will charm the
association to representatives. It likewise incorporates affecting these workers' choice to be
submitted and stay with the association notwithstanding when other openings for work exist
outside the association (Michael, 2008).
As per Taylor (2004), associations can never again stand to leave the duty regarding keeping
admirably – performing workers in the hands of the HR Department. Obligation and
responsibility for holding ability need to move out to the cutting edges and under the control
of pioneers. Pioneers and their expertise in building an atmosphere of maintenance, a culture
that addresses representatives in a way that urges them to stay, will be an association's best
guard against undesirable turnover. Pioneers are in this manner the mystery weapon in
keeping esteemed ability longer. A two way correspondence is viewed as a center
administration competency and a key administration obligation.
Pioneers ought to receive a style that would set up and affirm their initiative expert by
methods for seeming skillful and dependable. Successful pioneers should manage
individuals in a way that enables them to add to the accomplishment of the gathering'
general objective (Mat, 2008).
2.7Theoretical Framework
Leaders in the Health system have a role to play in retention of health workers. One
essential area of healthcare leadership skill is the use of different leadership styles (Casida
and Parker, 2011). The theoretical explanations of this study use the ideas and abstract
principles of situational leadership theory, Fielder’s Leadership Contingency Theory and the
33
transformational leadership theory as they relate to the topic on strategic leadership and
performance rather than the practical aspects and use.
2.7.1 The Behavioural Theories
Behavioural leadership theory is the opposite of Great Man Theory, the theory is placed
upon the belief of made leaders, that leaders are made not born. As from the name
behavioural, the theory stressed more on the leader’s actions not psychological or inner
qualities, Katzenbach& Smith, (2011). This theory strongly suggested that anyone could
learn to be a leader through some certain observations and studies.
Behavioral theories of leadership are classified as such because they focus on the study of
specific behaviors of a leader. For behavioral theorists, a leader behavior is the best
predictor of his leadership influences and as a result, is the best determinant of his or her
leadership success, (Rodgers, 2003).
The people oriented leaders are focusing their behaviors on ensuring that the inner needs of
the people are satisfied. Thus they will seek to motivate their staff through emphasizing the
human relation. People oriented leaders still focus on the task and the results; they just
achieve them through different means. Leaders with a people focus will have behaviors that
are in line with: encouraging, observing, listening and coaching and mentoring, (Lewin,
2015).
2.7.2 Institutional leadership theory
Selznick, one of the founding fathers of institutionalism, differentiates organizations from
institutions (Selznick, 2009). The previous are dispensable, may be oversubscribed,
outsourced or just extinguished; the latter are respected and indispensable, should not be
rejected, however ought rather to be conserved. For Selznick, institutionalization is that the
method whereby a company becomes an institution. It happens over time because the
organization is instilled with price "outside the technical requirements of the task at hand".
34
One among the leading vital procedures for instilling long-term which means and purpose to
daily behavior, reliable with Selznick, is that the amplification of socially integration
myths.
To Selznick, institutional management is stability and substitutes a good way to broaden
gaining knowledge of competencies. "The leader's action", maintains Selznick, is to check
the environs to discover which needs can end up essentially powerful threats, to exchange
the environment with the aid of tracing allies and diverse resources of outside guide, and to
gird his agency by means of creating the way and the desire to face up to attacks. leadership
need to now not simplest foster brotherly love closer to institutional safety, however make
situations with a purpose to make viable in the destiny what's excepted within the present.
2.7.3 Situational leadership theory
Situational leadership theory proposes that effective leadership requires a rational
understanding of the situation and an appropriate response, rather than a charismatic leader
with a large group of dedicated followers (Grint, 2011). Situational leadership in general and
Situational Leadership Theory (SLT) in particular evolved from a task-oriented versus
people-oriented leadership continuum (Lorsch, 2010). The continuum represented the extent
that the leader focuses on the required tasks or focuses on their relations with their
followers. Originally developed by Hershey & Blanchard (1996), SLT described leadership
style, and stressed the need to relate the leader’s style to the maturity level of the followers.
Task-oriented leaders define the roles for followers, give definite instructions, create
organisational patterns, and establish formal communication channels (Bass, 2008). In
contrast, relation-oriented leaders practice concern for others, attempt to reduce emotional
conflicts, seek harmonious relations, and regulate equal participation (Heath & Lee 2011).
35
Bass, (2008) argues that situational leadership theory lacks of consistency, conceptual
contradictions, and ambiguities. Other scholars suggested additional weaknesses of SLT.
Research revealed that no particular leadership style was universally effective and
behavioral theories relied on abstract leadership types that were difficult to identify. A
number of studies utilized have the situational leadership approach (Glynn &DeJordy,
2010).
The information in the article covered situational leadership theories, theoretical constructs
of effectiveness, and a description of four case studies of effective organisations. The study
addressed the concepts of leadership effectiveness, task orientation, relation orientation,
change leadership, and case study methodology. Larsson and Vinberg (2010) started from
the position of endorsing the relationship between leadership and organisational success.
Then they sought to identify the behaviors common to successful leadership across four
subject organisations. Larsson and Vinberg (2010) conducted the study from a qualitative,
comparative, positivist point of view. The authors discuss the implications as well as the
need for additional research.
2.7.4 Fielder’s Leadership Contingency Theory
The Concept of Strategic Leadership is anchored on the Fielder’s Leadership Contingency
Theory. This perspective was spearheaded by Fiedler (1967) who argues that a leader’s
effectiveness is dependent on the interaction of the leader’s style and characteristics of the
situation defined as leader-member relations, task –structure and leader –position power.
Situations surrounding an organisation will create different leadership style requirements for
a manager. The solution that a manager decides adopting regarding a situation is contingent
on the factors that impact on the situation (Bolden et al. 2003).
Although the contingency perspective purports to apply to all aspects of management, and
not just organizing and leading, there has been little development of contingency approaches
36
outside organisation theory and leadership theory. Dissatisfaction with Fielder’s Leadership
Contingency Theory effectiveness led to the development of trait based theories of
leadership. Various aspects of the situation have been identified as impacting the
effectiveness of different leadership styles. For example, Fiedler suggests that the degree to
which subordinates like or trust the leader, the degree to which the task is structured, and the
formal authority possessed by the leader are key determinants of the leadership situation.
Figure 2.0 Theoretical Framework
2.8 Conceptual Framework
From the fore mentioned theoretical framework discussion, this study adopts the World
health organization model (1996) which has been used in Gambia and worked and the health
care delivery points improved as a result of improved skills in leadership and
management.The key variables include translating theoretical health service delivery point
in the organization vision and optimization of the existing principles of governance in health
facilities within Meru County. This is a framework showing how the explanatory variables
(independent variables) affect the response variable (dependent variable). In this case, the
37
The Behavioural Theories
RETENTION OF
HEALTHCARE
WORKERS
Institutional leadership theory
Situational leadership theory
Fielder’s Leadership
Contingency Theory
independent variables are leadership competencies, types of leadership styles and leadership
qualities. The dependent variable is the health workforce retention.
See Figure 2.3.
Independent Variables Dependent Variable Outcome
→
→
.
CHAPTER THREE:
38
Leadership competencies
level of education
professional training
management level in the
organization
Retention of human
resources in
healthcare facilities
Health workers
satisfaction level
Attrition rate
Leadership styles
transactional,
transformational
level 5 leaders
laissez-faire
autocratic
servant,
democratic,
bureaucratic
Improved
Health
Service
delivery
Leadership qualities
Visionary
Listening skills
Sense of humour
Diplomatic
Humble
Admits mistakes
Learns from others
Figure 2:1 Conceptual Framework
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Introduction
This chapter deals with research methods that were applied in carrying out this study. It was
organized along the following sections: site selection and description, research design, target
population, sampling procedures and research instruments. The last part is a brief discussion
of the ethical issues, the reliability and validity of the study. A discussion on data collection
procedures and data analysis technique then follows.
3.2 Research Design
A descriptive survey design was utilized to examine part of initiative on maintenance of
wellbeing workforce in general wellbeing offices in Meru County, Kenya. Descriptive
design was picked in light of the fact that it had the benefit of delivering a decent measure of
reactions from an extensive variety of individuals. It additionally gives a reasonable picture
of occasions and individuals' conduct in light of information assembled at a point in time.
3.3 Site Selection and Description
The examination was directed in Meru County in the Eastern area of Kenya. The choice of
the zone of study was purposive as it represented the region where lapsed arrangement of
wellbeing is being executed, and there are private and religious wellbeing offices situated in
the locale. Meru County is found in the Eastern locale of Kenya, roughly 225 kilometers
Northeast of Nairobi. It covers a territory of 6,936 square kilometers. Meru imparts its
outskirt to five different provinces; Isiolo toward the North, Nyeri toward the South West,
Tharaka-Nithi toward the South West and Laikipia toward the West. Meru County is
comprised of nine bodies electorate; Igembe South, Igembe Central, Igembe North, Tigania
West, Tigania East, North Imenti, Buuri, Central Imenti and South Imenti.
39
Meru County has a Total Population of 1,356,301; 320,616 Households. The Population
thickness is 195.5 PER SQ. KM. There are more than 200 social insurance offices serving
the area – 103 keep running by the administration while the rest are either religious or
exclusive (2 Non-legislative, 56 Faith-based 204 Private). Prominent among them are the
Government doctor's facilities - Chuka County Hospital, Meru Teaching and Referral
County Hospital, Tigania Hospital, Miathene Sub-County Hospital, Nyambene Sub-County
Hospital and Kanyakine Sub-County Hospital. Church run offices incorporate Cottolengo
Mission Hospital, Maua Methodist Hospital and St.Theresa's Mission Hospital Kiirua
among others. Some private healing facilities incorporate Aga khan, Karen doctor's facility,
Laare Nursing and Maternity Home, Nyambene Clinical Services and Nursing and
Woodlands Hospital. There are 57 Nurses (per 100,000 individuals), 8 Doctors (per 100,000
individuals) and 7 Clinical officers (per 100,000 individuals).
3.4 Study Population
The study population of this research constituted of approximate 1,058 medical staff who
includes doctors, nurses, pharmacists, laboratory technicians, clinical officers, management
personnel workingin health facilities of tiers 2 to 4 public hospitals in Meru County.
According to the healthcare system in Kenya, 2014, Health facilities in Kenya are grouped
into six levels. Tier 1 is made up of community, Tier 2 provides Primary Care level Previous
KEPH levels 2 and 3 (Dispensaries Health centers), Tier 3: County level Previous KEPH
level 4 (District referral hospitals (47) and Tier 4: National level –Previous KEPH levels 5
and 6 Level 5 – Provincial referral hospitals (10) and Level 6 – National referral hospitals
(2).
40
3.5 Sampling procedure and the sample size determination
The researcher used simple stratified random sampling technique to recruit participants in
this study. The sampling frame was made from the records of health care workers and other
workers in the health facilities in Meru County. Records at the Meru County Public Service
department have the hospital workers contacts that include their cadre, the health facility
they are attached to, their contact information and other information. Using the table of
random numbers the desired sample size was drawn. This was to ensure that each member
of the study population had an equal chance of being recruited in the study.The desired
sample size was determined using the Cochran’s(1977) formula of sample size
determination.
Where;
Nis the desired sample size
N is the target populations, which in this study are 1058 health care workers in the health
facilities in Meru County.
e is the level of statistical significance. The level chosen for this study is 5% (0.05).
Therefore:
n= {1058}/ {1+1058(0.05)2} = 399.6
The desired sample size therefore was 400 health care workers in the public health facilities
in Meru County.
For the sampling of the health facilities to be visited, purposive sampling technique was
used to select Meru Teaching and Referral Hospital and key informants. Simple stratified
random sampling was used to select the number of hospitals (Tiers 2 – 4). Meru County has
41
207 hospitals. According to Gay (1992), a research study of this nature requires 30 cases or
more. This study proposed to visit 64 hospitals. From a sample of 63 hospitals, the formula
for calculating the proportion, variance, and confidence interval are presented here.
Point estimate for simple random sampling
^psrs=a/n
where
^
psrs=the estimated proportion
a=the number of hospitals with the attribute of interest - level
n=the number of hospitals sampled
Variance estimate for simple random sampling
v^
a r (^
psrs )= ^psrs ^qsrs
n−1
(
N−n
N
)
where
^
qsrs=1−^
psrs
N=population size
All the hospitals had equal chances of being selected. The following table summarizes the
sampling frame:
Table 3.1 Public health facilities in Meru County
Total number
(N)
Sample
(n)
Target number of
healthcare workers(N)
Number
sampled
Tier 4 1 1 392 91
Tier 3 5 3 254 81
Tier 2 201 60 412 92
Total 207 64 1,058 264
Retention was calculated through subtracting the number of healthcare workforce who had
quit the hospitals from the total number of healthcare workforce available during data
collection, divided by the total number of healthcare workforce and then multiplied by 100.
42
Retention percent=Total number of healthcare workforce -the number of quitted nurse ×
100
Total number of healthcare workforce
3.6 Research Instruments
3.6.1 Questionnaires
This study used questionnaires with closed- ended and open-ended questions. The closed
ended questions were included because they were easy to administer and analyze therefore,
they were economical in terms of time and money and allowed collection of data from a
large sample. The open-ended questions, on the other hand, were easy to formulate and
helpedto collect a more in-depth response from subjects.
Questionnaires we intended to elicit information about effect of leadership styles on job
retention of staff working in public hospital in Meru County. The questionnaires were pre-
tested to eliminate bias and ambiguity. There was a cover letter attached to each
questionnaire explaining the purpose of the study and requesting the co-operation of the
respondents. Respondents were given time to study and complete the questionnaires
distributed to them.
3.6.2 Questionnaire for the Head of department
This solicited information on the rate and trend of staff turnover in their hospitals, their
perceived leadership styles and its effect on staff retention. The questionnaire was to seek
any insights the Head of department may have that could improve leaders among the
hospital managers thus help reduce staff turnover and work performance.
43
3.6.3 Questionnaire for Staff
The questionnaire for hospital staff was administered to all cadre of health care workers
hospital workers, seeking to determine their gender, age, and academic and professional
qualifications, their perception of their leaders leadership styles and its effects on staff
turnover and job performance. It was also to allow the staff to give his/her own opinion on
factors contributing to staff turnover in the study region and means of reversing the trend.
3.7 Ethics when working with children and sensitive information
In this study, the following ethical issues was put into consideration: The researcher sought
permission from Director of education and the respective hospital management prior to
commencement of the research, in order for them to give informed consent for participation
in the study. The researcher explained the study purpose to respondents to ensure that they
understood what they were taking part in and how data was to be used. Information from the
target population was treated with the confidence that it deserved.
3.8 Reliability of the Instrument
Thorndike and Hagen (1961), points out that, instrument reliability refers to the level of
internal consistency, on the stability of the measuring device. An instrument is reliable,
when it can measure a variable accurately and consistently and obtain the same results under
the same conditions over time. For an instrument to be valid, it must be reliable. Roescoe
(1969), recommends the split-half method to access reliability of an instrument. Nachmias
and Nachmias (1976), Lokesh (1984), Borg & Gall (1996), concurs with this.
This involves breaking the instrument items into two equivalent halves (the odd-numbered
and even – numbered items). All the odd-numbered items were placed in one subset, while
44
all the even-numbered items were placed in another subset. Each of the two sub-sets was
treated separately and scored accordingly. The scores of each of the two sub-set was then
computed and the two scores corrected using Person’s Product Moment Correlation Co-
efficient, and then this was taken to be an estimate of reliability coefficient of the whole
inventory. The following formula was used to calculate correlation coefficient of the entire
test (Re).
Re= 2r
1+r
Where:
Re = Correlation Coefficient of the entire test
r = Correlation Coefficient of the even numbered statement with
the scores of the Odd numbers statements.
The value “r” obtained indicated the degree to which the two halves/subsets are internally
consistent. Reliability coefficient rages from values of 0.000 and +1.00 indicating perfect
reliability. If the two scores rages from 0.1 and above up-to 1.0, the instrument is said to be
reliable.
3.9 Validity of the Instruments
To enhance the validity of the questionnaire, the researcher pre-tested (pilot study) on a
population similar to the target population.Mulusa (1988) recommends about 10 cases,
which represent the target population in all major aspects, should be used in a pre-test. The
interview schedules were pre-tested in Mutuati Sub-County Hospital in Meru County. Isaac
and Michael (1981) stated the objectives of pilot-study; it enables the researcher to get
feedback from research subjects that need improvements in the main study, leads to changes
45
to some assumption, dropping some and developing new ones and increases the chances of
obtaining clear-cut findings in the study.
3.10Pre-Test Results
The examination was coordinated in Meru County in the Eastern range of Kenya. The
decision of the zone of study was purposive as it represented the district where passed game
plan of prosperity is being executed, and there are private and religious prosperity
workplaces arranged in the area. Meru County is found in the Eastern district of Kenya,
approximately 225 kilometers Northeast of Nairobi. It covers a domain of 6,936 square
kilometers. Meru confers its edge to five distinct areas; Isiolo toward the North, Nyeri
toward the South West, Tharaka-Nithi toward the South West and Laikipia toward the West.
Meru County is contained nine bodies electorate; Igembe South, Igembe Central, Igembe
North, Tigania West, Tigania East, North Imenti, Buuri, Central Imenti and South Imenti.
Meru County has a Total Population of 1,356,301; 320,616 Households. The Population
thickness is 195.5 PER SQ. KM. There are more than 200 social protection workplaces
serving the range – 103 continue running by the organization while the rest are either
religious or selective (2 Non-administrative, 56 Faith-based 204 Private). Conspicuous
among them are the Government specialist's offices - Chuka County Hospital, Meru
Teaching and Referral County Hospital, Tigania Hospital, Miathene Sub-County Hospital,
Nyambene Sub-County Hospital and Kanyakine Sub-County Hospital. Church run
workplaces fuse Cottolengo Mission Hospital, Maua Methodist Hospital and St.Theresa's
Mission Hospital Kiirua among others. Some private mending offices fuse Aga khan, Karen
specialist's office, Laare Nursing and Maternity Home, Nyambene Clinical Services and
Nursing and Woodlands Hospital. There are 57 Nurses (per 100,000 people), 8 Doctors (per
100,000 people) and 7 Clinical officers (per 100,000 people).
46
Table 3.2 Reliability Results
Variable Cronbach’s Alpha Items
Leadership competencies .71 4
Types leadership styles .73 3
Leadership qualities .75 2
3.11 Data Collection Procedures
The researcher with the help of two research assistants administered research instruments. A
research permit to conduct the study was obtained from the MoE, Science and Technology
offices in Nairobi. The researcher then obtained permission from KeMU Scientific Research
and Ethics Committee and Meru County authority to carry out the data collection. The
primary data was collected from health care workers in public hospitals (Tier 2- 4) who
were the respondents through use of structured questionnaires and interview schedule
respectively. The letters of introduction were sent to all selected hospitals that were to
participate in the main study before its commencement. Each of the health facilities was
informed that their hospital was selected for the study and their co-operation would be
highly appreciated. The researcher visited the hospitals to administer the questionnaires to
staff and head of departments. The researcher identified research assistants through
purposive sampling method and trained them on the use of the data collection tool to
ascertain validity and reduce bias. The questionnaire was administered personally by the
researcher and his assistants, filled and collected on the same day as per agreed dates
between the researcher and the respondents. The staff completed their response to the items
included in the questionnaire in the presence of the researcher and the assistant, who then
collected the completed questionnaires.
47
3.12 Data Analysis
In the process of bringing order, structure and interpretation to the mass of collected data,
both qualitative and quantitative data was analyzed. The data analysis was initiated by
examining the gathered raw data for accuracy, usefulness and completeness. The objective
behind editing is to identify those items that maybe incorrectly responded to such as
spelling mistakes and blank spaces left unfilled by the respondents.
This data was then tabulated and classified in qualified terms (Lokesh, 1984). This
involved the transfer of classified data gathering tools to the tabular form in which they
were systematically examined. Descriptive statistics was adopted for presenting and
analyzing the data patterns in the responses from the sample and summarized by the use of
frequency tables and percentages. However, inferential statistics was used, where
necessary, to determine if the patterns described in the sample could be applied to the
population from which the sample is drawn.
Types of statistics used depended on the type of variable in the study and the scale of
measurement for example ratio, interval, ordinal or nominal. SPSS software was used to
generate descriptive statistics, that is, mean, percentages, mode and frequency distributions.
The results are presented in charts, graphs and tables.
48
CHAPTER FOUR: RESULTS ANDDISCUSSION
4.1 Introduction
This chapter gives details on research results and analysis based on the study objectives that
were; to determine the relationship between health managers leadership competencies of
health care managers influence on retention of health, to determine the influence of
managers leadership styles on retention of health workers, to determine the influence of
managers leadership qualities on retention of health workers in Meru County.
Included in the chapter data processing and coding. In addition, results and analysis form
part of the chapter.
4.2Respondents’ Characteristics
The study sought to determine the general information from the respondents. The
information is presented in the following section
4.2.1 Respondent’s Age
The researcher had to establish the age of the respondents. The study results show that
(n=32) 12% of the respondents were aged between 25 to 30 years, 129 (49%) were aged
between 31 to 40 years, 77(29%) were aged between 41 to 50 years while 26.4 (10%) were
aged above 50 years. The results were positive to the study since the respondents were
mature enough to understand the dynamics of leadership and employee retention.
49
The results are presented in Figure 4.1
Figure 4:1 Respondents’ Age
25-30 years 31-40 years 41-50 years Over 50 years
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
12%
49%
29%
10%
4.2.2 Gender
The researcher had to establish the gender of the respondents. The study above shows that
(n=211)80% of the respondents were while (n=53)20% were female. Both genders were
represented and the response on leadership and employee retention was well balanced.
The results are recorded in the following figure 4.2
Figure 4:2 Gender
80%
20%
Male
Female
4.3.3 Length of Time in Position
The researcher had to establish the length in position of the respondents. The study above
shows that (n=187)71% of the respondents had served between 5 to 10 years, (n=21)8% had
50
served between 10 to 15 years while (n=58)22% had served for 15 years and above. The
average length was good enough to render reliable data and information in regard to
influence of leadership and employee retention.
The results are recorded in figure 4 below.
Figure4.3 Length of Time in Position
39%
27%
14%
5 to 10 years
10 to 15 years
16 to 20 years
4.3.4 Length of Time at the Current Workstation
The researcher had to find out the length the respondents had served at the station.The study
above shows that (n=660)25% of the respondents had worked at the station for between 1 to
5 years, (n=114)43% had worked for between 5 to 10 years, (n=63)24% had stayed for
between 10 to 15 years, (n=13)5% had stayed for between 16 to 20 years while (n=8)3% had
stayed for above 20 years. The length of time at station was adequate to understand the
modalities of leadership and employee retention. The results were recorded in the following
figure 4.4
51
Figure 4.4 Length of Time at the Station
1 to 5 years 5 to 10 years 10 to 15 years 16 to 20 years above 20 years
0%
5%
10%
15%
20%
25%
30%
35%
40%
15%
39%
27%
14%
5%
4.3.5 Length of Time in Healthcare Service
The researcher had to find out the length of time in healthcare service. The study shows that
(n=40)15% of the respondents had been in the healthcare service for between 1 to 5 years,
(n=103)39% had been for between 5 to 10 years, (n=71)27% had been in service for
between 10 to 15 years, (n=37)14% had been in service for between 16 to 20 years while
(n=13)5% had been in service for above 20 years. The results were recorded in the
following figure 4.5
Figure4:5 Length of Time in Healthcare Service
52
1 to 5 years 5 to 10 years 10 to 15 years 16 to 20 years above 20 years
0%
5%
10%
15%
20%
25%
30%
35%
40%
15%
39%
27%
14%
5%
4.3.6 Level of Education
The researcher had to find out the level of education of the respondents.The study above
shows that majority of the respondents (n=174)66% had a diploma while the less than half
(n=90)34% had a university degree. Both the respondents were well educated to respond to
the questionnaire more appropriately. The study further indicated the certificate obtained
was diploma in nursing and diploma in pharmaceutical technology.
From the study above, it is apparent that the majority of the respondents (n=174) 66% had a
diploma. The education level was ideal in understanding the dynamics of leadership and
employee retention. The respondents further could read and interpret the questionnaire
effectively with little assistance from the researcher.
The results were recorded in the following figure 4.6
53
Figure 4:6 Level of Education
66%
34%
Diploma
University
Cross tabulation of Gender and retention of health workforce
The below cross tabulation of gender against Satisfaction Level on the role of leadership on
retention of human resources indicates that the female respondents were moderately
satisfied as indicated by 64%. However, the male counterparts too were moderately
satisfied as supported by 59%. It is therefore apparent that the Satisfaction Level on the role
of leadership on retention of human resources of both genders is moderate.
54
Table 4.1 Gender and retention of health workforce
Gender * retention of health workforce
Satisfaction Level on retention of human resources
Total
Highly
satisfied Satisfied
Moderately
satisfied Dissatisfied
Extremely
Dissatisfied
Gender Male Count 4 15 121 32 32 204
% within
Gender
2.0% 7.4% 59.3% 15.7% 15.7% 100.0%
Female Count 6 15 108 24 15 168
% within
Gender
3.6% 8.9% 64.3% 14.3% 8.9% 100.0%
Total Count 10 30 229 56 47 372
% within
Gender
2.7% 8.1% 61.6% 15.1% 12.6% 100.0%
4.4 Assessment of Leadership Competency Skills
Therefore, the preceding section entails the respondents view concerning leadership
competency skills.
4.4.1 Leadership Qualities
The results in table 4.1 above shows that (n=124) 47% of the respondents indicated a lot of
time, (n=108) 41% were for some of the time while (n=32) 12% were for Very little / none
of the time to the idea that they reflected on how my own values and principles influence
their behavior and affect others. Developing self-awareness had an overall standard
deviation of .874.
The study further reveals that, (n=135) 51%supported the idea of working with others to
achieve a common objective. This is supported by a standard deviation of .652.For some of
55
the time while (n=132) 50% were for very little / none of the time to the idea that they
shared information and resources across networks.
Table 4.2 Leadership Qualities
NO DEVELOPING SELF
AWARENESS
A lot of
the
time
N (%)
Some of
the time
N (%)
Very little /
None of the
time
N (%)
Mean SD
1 I reflect on how my own values
and principles influence my
behavior and impact on others
124 (47) 108 (41) 32 (12) 4.253 .874
2 I seek feedback from others on my
strengths and limitations and
modify my behavior accordingly
127(48) 92(35) 45(17) 4.045 .541
MANAGING YOURSELF
1 I remain calm and focused under
pressure
100(38) 129 (49) 34(13) 3.985 .823
2 I plan my workload and deliver on
my commitments to consistently
high standards demonstrating
flexibility to service requirements
124(47) 58(22) 82(31) 3.487 .451
CONTINUING PERSONAL
DEVELOPMENT
1 I actively seek opportunities to
learn and develop
119(45) 77(29) 69(26) 4.124 .354
2 I apply my learning to practical
work
114(43) 92(35) 58(22) 3.846 .658
ACTING WITH INTEGRITY
1 I act in an open, honest and
inclusive manner - respecting
other people’s culture, beliefs and
abilities
137(52) 66(25) 61(23) 4.254 .541
2 I speak out when I see that ethics
or values are being compromised
103(39) 108(41) 53(20) 3.641 .461
WORKING WITH OTHERS
1 Developing Networks 119(45) 95(36) 50(19) 4.641 .451
2 I identify opportunities where
working collaboratively with
others will bring added value to
patient care
63(24) 135(51) 66(25) 3.785 .652
3 I share information and resources
across networks
32(12) 100(38) 132(50) 4.561 .354
56
4.4.2 LEADERSHIP STYLES
The researcher sought to establish the leadership styles applied at health in public health
facilities in Meru County.The t-test indicates three research factors have a solid likelihood
connection with initiative competency aptitudes. These are Managing yourself with
likelihood of 47% (t=3.944), Continuing Personal Development with 36% (t=3.137) and
Acting with respectability with 41% (t=3.720). From the investigation above, unmistakably
administration qualities influence representative maintenance. Lion's share of the
respondents demonstrated that they had most attractive administration qualities. These
discoveries were in accordance with Gwavuya (2011) who certifies that clumsy authority
brings about poor representative execution, high anxiety, low occupation responsibility, low
employment fulfillment and turnover goal. Research directed on the province of South
African Training industry showed that administration style was the most unmistakable
maintenance factor in South Africa (Netswera et al, 2005). Sherman etal (2006) found in
their exploration that dominant part of the representatives in associations reviewed wanted
to stay with their associations at any rate for the following five years due to the overall
culture of administration mind. Bite (2004) watched that administration conduct affects
authoritative responsibility and turnover goal. The results were recorded in the following
table 4.3
Table 4:3 Leadership Styles
BUILDING AND MAINTAINING
RELATIONSHIPS
A lot
of the
time
N (%)
Some
of the
time
N (%)
Very
little /
None
of the
time
N (%)
Mean SD
1I communicate clearly and effectively
with others
108(41) 90 (34) 66 (25) 4.234 .641
57
2I listen to and take into account the
needs and feelings of others
129(49) 100(38) 34 ( 13) 3.231 .218
ENCOURAGING CONTRIBUTION .524
1I actively seek contributions and views
from others
95 (36) 135(51) 34(13) 3.214 .244
2I am comfortable managing conflicts of
interests or differences of opinion
121(46) 48 (18) 95 (36) 4.265 .641
WORKING WITHIN TEAMS .218
1I put myself forward to lead teams,
whilst always ensuring I involve the
right people at the right time
166(63)
74 (28) 24 ( 9) 4.325 .524
2I acknowledge and appreciate the efforts
of others within the team and respect the
team’s decision
187(71) 55 (21) 21( 8) 5.231 .244
It is clear from the investigation that (n=187) 71% of the respondents demonstrated a ton of
time, (n=55) 21% were for as a rule while (n=21)8% were for next to no/none of the
opportunity to the possibility that they recognized and valued the endeavors of others inside
the group and regard the group's choice. This was upheld by a standard deviation of .244
Besides, that (n=95) 36% of the respondents demonstrated a considerable measure of time,
(n=135) 51%) were for as a less than dependable rule while (n=34) 13% were for almost
no/none of the opportunity to the possibility that they effectively look for commitments and
perspectives from others. Confidently, the outcomes demonstrates that (n=166) 63%) of the
respondents showed a ton of time, (n=74, 28%) were for as a rule while (n=24) 9% were for
almost no/none of the opportunity to the possibility that they put themselves forward to lead
groups, while continually guaranteeing they include the perfect individuals at the correct
time.
58
Table 4.4 ANOVA test of leadership styles and health work force retention
ANOVAa
Model Sum of Squares df Mean Square F Sig.
Regression 4.771 5 .954 8.179 .000b
Residual 5.600 48 .117
10.370 53Total
Dependent Variable: health workforce retention
Predictors: (Constant), Encouraging contribution, Building and maintaining relationships and working within teams
Since the p-value of factor statistics is <1, there is strong statistical significance between
leadership styles and health human resources retention under study. The f-value is 8.179,
which is a strong indicator of variables health human resources retention. It is therefore clear
that leadership styles are a crucial element of health human resources retention.
Table 4.5 Managing services and Resources
A lot
of the
time
N (%)
Some
of the
time
N (%)
Very
little /
None
of the
time
N (%)
Mean SD
MANAGINGSERVICES
1Planning 92(35) 121(46) 50 ( 19) 5.213 .4644
2I use feedback from patients, service
users and colleagues when developing
plans
161(61) 92 (35) 11 (4) 4.321 .5411
59
3I assess the available options in terms of
benefits and risks
129(49) 66 (25) 69 (26) 3.214 .6854
4Managing Resources 142(54) 95 (36) 26 (10) 4.235 .3204
MANAGING RESOURCES .3964
1I deliver safe and effective services
within the allocated resource
150(57) 61 (23) 53 ( 20) 5.325 .3212
2I take action when resources are not
being used efficiently and effectively
92 (35) 143(54) 29 (11) 4.214 .3684
The study above reveals that, (n=150) 57% of the respondents indicated deliver safe and
effective services within the allocated resource. This was supported by a standard deviation of
.3684.
Managing Resourceswas an important element with (n=143) 54% supporting that that they
took action when resources are not being used efficiently and effectively this too had a
standard deviation of .3204.
Table 4.6 Regression analysis between managing resources and retention of health
work force
Model Summary
Model R R Square
Adjusted R
Std. Error of the
Square Estimate
1 .678a.460 .404 .342
a. Predictors: (Constant), Managing services and Resources
b. Dependent: health human resources retention
60
With Managing services and Resources, 46% of is explained by all independent
variables in the study. This falls short of the 50% mark by only 4%.
Table 4.7Managing People and Performance
BUILDING AND MAINTAINING
RELATIONSHIPS
A lot
of the
time
N (%)
Some
of the
time
N (%)
Very
little /
None of
the
time
N (%)
Mean SD
MANAGING PEOPLE
.541
1I support team members in developing
their roles and responsibilities
166 (63) 74 (28) 24( 9)
5.231 .674
2I provide others with clear purpose and
direction
108 (41) 84 (32) 71 ( 27)
4.214 .652
MANAGING PERFORMANCE
.574
1I analyze information from a range of
sources about performance
132 (50) 77 (29) 55 ( 21)
5.214 .974
2I take action to improve performance 100 (38) 124(47) 40 (15)
4.236 .541
In addition, (n=166) 63% of the respondents indicated a lot of time, (n=74) 28% were for
some of the time while (n=24) 9% were for very little / none of the time to the idea that they
supported team members in developing their roles and responsibilities.
Further, (n=108) 41% of the respondents indicated a lot of time, (n=84) 32% were for some
of the time while (n=71) 27% were for very little / none of the time to the idea that they
provided others with clear purpose and direction. On the other hand, (n=132) 50% of the
respondents indicated a lot of time, (n=77) 29% were for some of the time while (n=55)
21% were for very little / none of the time to the idea that they analyze information from a
range of sources about performance. Moreover, (n=100) 38% of the respondents indicated a
61
lot of time, (n=124) 47% were for some of the time while (n=40, 15%) were for very
little/none of the time to the idea that they take action to improve performance.
Table 4.8 Improving Services through leadership
A lot of
the time
N (%)
Some of
the time
N (%)
Very
little /
None
of the
time
N (%)
Mean SD
IMPROVING SERVICES
1Ensuring Patient Safety 74 (28) 166(63) 24( 90) 5.254 .5421
2I take action when I notice
shortfalls in patient safety
148(56) 90 (34) 26 (10) 4.236 .5451
3I review practice to improve patient
safety and minimize risk
119(45) 100(38) 45 (17) 5.236 .5744
4Critically Evaluating 148(56) 100(38) 16 (6) 5.214 .6875
5I use feedback from patients,
careers and service users to
contribute to improvements in
service delivery
143(54) 100(38) 28 (8) 4.235 .3454
6I work with others to constructively
evaluate our services
129(49) 108(41) 26 (10) 4.326 .5421
7Encouraging Improvement and
Innovation
61 (23) 119(45) 84 (32) 4.236 .5451
The study indicates that (n=148) 56% of the respondents indicated a lot of time, (n=90) 34%
were for some of the time while (n=26) 10% were for very little / none of the time to the
idea that they took action when they notice shortfalls in patient safety. The majority of
respondents (n=177) 67%indicated that they take action when they notice shortfalls in patient
safety, (n=63) 24% were for some of the time while (n=24) 9% were for very little / none of
62
the time to the idea that they put forward ideas to improve the quality of services. Finally,
(n=55) 21% of the respondents indicated a lot of time, (n=135) 51% were for use feedback
from patients, careers and service users to contribute to improvements in service delivery.
Table 4.9 ANAOVA test between Improving Services through leadership and retention
of health workforce
ANOVAaff
Model Sum of Squares df Mean Square F Sig.
Regression 1.159 7 .166 2.936 .013b
1 Residual 2.539 45 .056
Total 3.698 52
a. Dependent Variable: Health work force retention
b. Predictors: (Constant), Improving Services
The noteworthiness estimation of 0.013 (p < 0.05) affirms that for sure there is a factual
hugeness between the enhancing administrations and wellbeing HR retention.
4.4.3 Leadership Competencies
The researcher had to establish how leadership competencies are applied at health in public
health facilities in Meru County. The results were recorded in table 4.3 below for
interpretation purposes.
Table 4.10Leadership Competencies
A lot
of the
time
N (%)
Some
of the
time
N (%)
Very
little /
None of
the time
N (%)
FACILITATING TRANSFORMATION
1I articulate the need for change and its impact on people
and services
166(63) 77(29) 21(8)
63
2I focus myself and motivate others to ensure change
happens
112(43) 95(36) 55 (21)
SETTING DIRECTION
1I identify the drivers of change (e.g. political, social,
technical, economic, organizational, professional
environment)
63(24) 140(53) 61(23)
2I anticipate future challenges that will create the need for
change and communicate these to others
66( 25) 106
(40)
92 (35)
APPLYING KNOWLEDGE AND EVIDENCE
1I use data and information to suggest improvements to
services
164(62) 82 (31) 18(7)
2I influence others to use knowledge and evidence to
achieve best practice
124(47) 100(38) 40 (15)
The study from table 4.3 indicates that, (n=166) 63% of the respondents were for a lot of
time, (n=77) 29% were for some of the time while (n=21) 8% were for very little / none of
the time to the idea that they articulated the need for change and its impact on people and
services. On the other hand, (n=112) 43% of the respondents were for a lot of time, (n=95)
36% were for some of the time while (n=55) 21% were for very little / none of the time to
the idea that they focus themselves and motivate others to ensure change happens.
It is apparent from the study above that facilitating transformation is a key leadership
competency. The respondents upheld this through understandable the requirement for
change and its effect on individuals and administrations and center myself and propel others
to guarantee change happens. These outcomes were in accordance with Beard, (2007)
watches that the part of administration and an administrator is vital in staff maintenance, and
contends that representatives leave directors not organizations.
Gwavuya (2011) asserts that awkward administration brings about poor worker execution,
high anxiety, low employment responsibility, low occupation fulfillment and turnover goal.
64
Research led on the territory of South African Training industry showed that administration
style was the most unmistakable maintenance factor in South Africa (Netswera et al, 2005).
Sherman etal (2006) found in their exploration that larger part of the workers in associations
studied wanted to stay with their associations in any event for the following five years as a
result of the predominant culture of administration mind. Bite (2004) watched that
administration conduct impacts authoritative duty and turnover goal. Muindi (2011) built up
that initiative style, particularly absence of inclusion in basic leadership and lacking
correspondence were a portion of the issues that caused disappointment of scholarly staff
University of Nairobi. In this manner, writing demonstrates that authority style is significant
in staff maintenance.
Table 4:11 Leadership Competencies
A lot
of the
time
N (%)
Some
of the
time
N (%)
Very
little /
None of
the time
N (%)
FACILITATING TRANSFORMATION
1I articulate the need for change and its impact on people
and services
166(63) 77(29) 21 (8)
2I focus myself and motivate others to ensure change
happens
112(43) 95(36) 55(21)
SETTING DIRECTION
1I identify the drivers of change (e.g. political, social,
technical, economic, organizational, professional
environment)
63(24) 140(53) 61(23)
2I anticipate future challenges that will create the need for
change and communicate these to others
66(25) 106(40) 92(35)
APPLYING KNOWLEDGE AND EVIDENCE
1I use data and information to suggest improvements to 164(62) 82(31) 18(7)
65
services
2I influence others to use knowledge and evidence to
achieve best practice
124(47) 100(38) 40(15)
The study from table 4.3 indicates that, (n=166)63% of the respondents were for a lot of
time, (n=77) 29% were for some of the time while (n=21) 8% were for very little / none of
the time to the idea that they articulated the need for change and its impact on people and
services. On the other hand, (n=112) 43%of the respondents were for a lot of time, (n=95)
36%were for some of the time while (n=55) 21% were for very little / none of the time to
the idea that they focus themselves and motivate others to ensure change happens.
It is apparent from the study above that facilitating transformation is a key leadership
competency. The respondents supported this through articulating the requirement for change
and its effect on individuals and administrations, center myself, and propel others to
guarantee change happens. These outcomes were in accordance with Beard well (2007) who
watches that the part of administration and a chief is pivotal in staff maintenance, and
contends that workers leave directors not organizations.
Gwavuya (2011) insists that bumbling authority brings about poor worker execution, high
anxiety, low employment responsibility, low occupation fulfillment and turnover
expectation. Research led on the territory of South African Training industry showed that
administration style was the most conspicuous maintenance factor in South Africa
(Netswera, 2005). Sherman etal (2006) found in their exploration that lion's share of the
workers in associations reviewed intended to stay with their associations at any rate for the
following five years as a result of the predominant culture of administration mind. Bite
(2004) watched that initiative conduct affects hierarchical duty and turnover aim. Muindi
66
(2011) built up that initiative style, particularly absence of association in basic leadership
and deficient correspondence were a portion of the issues that caused disappointment of
scholarly staff University of Nairobi. In this manner, writing shows that administration style
is urgent in staff maintenance.
Table 4.12 Making Decisions and Creating the Vision
A lot
of the
time
N (%)
Some
of the
time
N (%)
Very
little /
None of
the time
N (%)
MAKING DECISIONS
1I consult with key people and groups when making
decisions taking into account the values and priorities of
the service
127(48) 100(38) 37(14)
2I actively engage in formal and informal decision-making
processes about the future of services
19(74) 55( 21) 13( 5)
3Evaluating Impact 100(38) 63( 24) 100( 38)
4I take responsibility for embedding new approaches into
working practices
53(20) 129(49) 82( 31)
5I evaluate the impact of changes on patients and service
delivery
103(39) 66( 25) 95( 36)
CREATING THE VISION
1I actively engage with others (including patients and
public) to determine the direction of the organization
153(58) 71(27) 40 (15)
2I take into account the full range of factors that will 90 (34) 129(49) 45(17)
67
impact upon the future of health and care services
In addition, (n=127) 48% of the respondents were for a lot of time, (n=100) 38%were for
some of the time while (n=37) 14% were for very little / none of the time to the idea that
they consulted with key people and groups when making decisions taking into account the
values and priorities of the service. Further, (n=195) 74% of the respondents were for a lot
of time, (n=55) 21% were for some of the time while (n=13) 5% were for very little / none
of the time to the idea that they effectively participate in formal and casual basic leadership
forms about the eventual fate of administrations. The discoveries are in accordance with
Taylor (2004) thatorganizations can never again stand to leave the duty regarding keeping
great – performing representatives in the hands of the HR Department. Obligation and
responsibility for holding ability need to move out to the bleeding edges and under the
control of pioneers. Pioneers and their expertise in building an atmosphere of maintenance, a
culture that addresses workers in a way that urges them to stay, will be an association's best
barrier against undesirable turnover. Pioneers are in this way the mystery weapon in keeping
esteemed ability longer.
Table 4.13Influencing the Vision of the Wider Healthcare System
A lot
of the
time
N (%)
Some
of the
time
N (%)
Very
little /
None of
the time
N (%)
INFLUENCING THE VISION OF THE WIDER
HEALTHCARE SYSTEM
1I look for opportunities to engage in debate about the
future of healthcare
103(39) 119(45) 42 ( 16)
2I influence key decision makers who determine future
government policy that impacts the NHS and its services
90(34) 48(18) 127 (48)
COMMUNICATING THE VISION
1I communicate the vision with enthusiasm and clarity 66(25) 119(45) 79 (30)
68
2I take time to build critical support for the vision 108(41) 84(32) 71 (27)
EMBODYING THE VISION
1I show confidence, commitment and passion for the
vision in my day to day actions
127
(48)
71(27) 66 (25)
2I challenge behaviour, symbols & rituals which are not
consistent with the vision
140(53) 100(38) 24 ( 9)
In addition, (n=103) 39% of the respondents were for a lot of time, (n=119) 45% were for
some of the time while (n=42) 16% were for very little / none of the time to the idea that
they look for opportunities to engage in debate about the future of healthcare. Nevertheless,
(n=90) 34% of the respondents were for a lot of time, (n=48) 18% were for some of the time
while (n=127) 48%were for very little / none of the time to the idea that theyimpact key
chiefs who decide future government arrangement that influences the NHS and its
administrations. These discoveries were in accordance with Mat, 2008 who contends that
successful pioneers should direct individuals in a way that enables them to add to the
accomplishment of the gathering' general objective (Mat, 2008). Representatives will
probably stay with an association on the off chance that they conviction that their chiefs
demonstrates intrigue and worry for them, on the off chance that they realize what is
anticipated from them, on the off chance that they are given a part that fits their capacities
and on the off chance that they get standard positive criticism and acknowledgment. The
nature of relationship a worker has with his or her prompt directors lengthens representative
remain in an association (Ferreira, 2007 referred to in Michael, 2008).
69
4.4.4 Leaders’ Competency Skill and Retention of Workers
The researcher had to find out whether the individual leaders’ competency skill has any role
on retention of health workforce retention. The results were recorded in the following figure
4.7
Figure4:2Retention of health Workers
Yes No
0%
10%
20%
30%
40%
50%
60%
70%
69%
31%
The study above shows that (n=182)69% of the respondents agreed while only (n=81, 31%)
disagreed that individual leaders’ competency skill has any role on retention of health
workforce retention.The respondents showed that compelling competency administration
makes a constant and prescient stock of the capacity of any workforce. By characterizing
work parts and related competency capability, initiative can promptly distinguish qualities
and aptitude holes. Competency administration at that point educates focused on aptitudes
improvement learning arrangements enhancing individual and authoritative execution,
prompting better business comes about.
A transformational authority style makes a dream and moves subordinates to endeavor past
required desires, though value-based initiative concentrates more on outward inspiration for
70
the execution of employment assignments (Jung DI (2001)). They raise their devotees'
familiarity with authoritative issues and their outcomes, they make a dream of what the
association ought to be, fabricate sense of duty regarding that vision all through the
association, and encourage hierarchical changes that help the vision (Certon, 2000).
Transformational initiative is not the same as value-based pioneers who describe various
associations who are attempting to adapt to the present quick ecological changes.
4.4.5 Number of employees
The researcher had to find out the employees are there in your whole health facility.
Figure 4:8 Numbers of employees
Between 20 to
50
50 to 80 80 to 100 100 and above
0%
5%
10%
15%
20%
25%
30%
35%
40%
20%
39%
26%
15%
The study above shows that (n=53)20% of the respondents indicated a total of between 20 to
50 employees, (n=103)39% were for between 50 to 80 employees, (n=69)26% were for
between 80 to 100 employees while (n=40)15% indicated above 100 employees.
Value-based pioneers are experts at controlling assets, methodology and schedules (Darling,
2002). They are overseers of business as usual (Warburton, 2007) who think as far as
reasonability, with an attention on control and responsibility (Bennis, 2010). These pioneers
identify with different performing artists in part terms and support reliability, congruity,
coordination and camaraderie (Fairholm, 2000). They lean toward security and are viable in
71
circumstances where they can coordinate the coveted conduct, control deviation from set
standards, and rebuff hard-headedness (Zemke, 2009).
4.4.6 Employees Left
The researcher had to find out whether there been employees who have left this health
facility. The results were recorded in the following figure 4.9
Figure 4:9 Employees Left
78%
22%
Yes
No
The study above shows that (n=58)78% of the respondents said yes while (n=206)22% said
noon the idea that there been employees who have left this health facility. The researcher
further sought to establish the exact number of employees left. The results were recorded in
the following figure 4.10.
Figure 4:10 Number of Left employees
72
10-20 Employees 20-30 Employees 30-40 Employees Above 40
0%
10%
20%
30%
40%
50%
60%
15%
59%
21%
5%
The results above shows that (n=48)18% of the respondents indicated that between 10 to 20
employees left, (n=132)50% were for between 20 to 30 employees, (n=82)31%indicated 30
to 40 employees while (n=30)1% were for above 40 employees.
These discoveries were in accordance with Chin and Gaynier (2006), to convey
consideration regarding binding together factors that undergird associations and individuals.
The creators affirmed that in the worldwide commercial center, social elements are basic to
hierarchical change and authority achievement. For an association, culture incorporates
shared esteems and controlling standards, and altogether impacts an association's benefit and
general execution.
The researcher had to find out the current shortage of staff in this facility. The results were
recorded in the following figure 4.11
Figure 4:11Current shortage
73
10-20 Employees
20-30 Employees
30-40 Employees
Above 40
0% 10% 20% 30% 40% 50% 60%
15%
59%
21%
5%
The study above shows that (n=40)15% of the respondents indicated there was a shortage of
between 10 to 20 employees, (n=156)59% indicated 20 to 30 employees, (n=55)21%
indicated 30 to 40 employees while (n=40)15% indicated above 40 employees. The
researcher had to find out the effect of the shortage to the service delivery. The results
indicated that nurses regularly tell us that they are too busy to provide the standard of care
they would like. When staffs are pushed to breaking point, patient care is the inevitable
casualty.
The analyst looked to build up the impression of the respondents on influential position on
staff maintenance at this wellbeing office. The respondents demonstrated that few expert
associations have created official articulations tending to the national nursing lack and high
turnover rate among staff medical caretakers. Announced healing facilities that have
effectively enlisted and held staff medical attendants have pioneers who showed
competency in their part, are reliable, and esteem and bolster the commitments of their
workers.
74
4.5 Assessing Leadership Styles
The preceding section entails response on the role of leadership styles on retention of human
resources at healthcare facilities in Meru County. The questions were targeted to health care
staff. The desired sample size therefore was 400 health care workers in the public health
facilities in Meru County.
4.5.1 Age theresearcher had to establish the age of the respondents. The results were
recorded in the following figure 4.12
Figure 4:12 Age
20 – 29 years 30 – 39 years 40 – 49 years
50 – 59 years 60 and above
years
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
18%
24%
41%
12%
5%
The study above shows that (n=72)18% of the respondents were aged between 20 to 29
years, (n=96)24% were aged between 30 to 39 years, (n=164)41% were aged between 40 to
49 years, (n=48)12% were aged between 50 to 59 years while (n=20)5% were 60 and above
years. From the study above, the age brackets were well represented to carry the study out.
4.5.2 Gender
The gender of the respondents was represented in the following figure 4.13
Figure4:13Gender
75
45%
Male
Female
The study above shows that (n=220)55% of the respondents were female while
(n=180)45%weremale. However, both genders were well represented to carry the study out.
4.5.3 Level of Education
The researcher had to find out the level of education of the respondents. The results were
recorded in the following figure 4.14
Figure4:14 Level of Education
76
67%
33%
Diploma
University degree
The study above shows that (n=132)33% had a diploma while the majority (n=268)67% had
a university degree. Both the respondents were well educated to respond to the questionnaire
more appropriately.
4.5.4 Current position in this health facility
Figure 4:15 Current position in this health facility
Nursing officer 3
Community health officer
Service provider
Clinical officer in chest clinic
Clinical officer
0%
5%
10%
15%
20%
25%
30%
35%
40%
39%
24%
17%
8%
12%
The study above shows that (n=156)39% of the respondents were nursing officers,
(n=96)24% were community health officers, (n=68)17% were service providers,
(n=32)8%were clinical officer in chest clinic while (n=48)12% were clinical officers.
77
However, majority of the respondents indicated their previous positions as nursing officer
two.
4.5.5 Length in service
The researcher sought to find out how long the respondents had served in the facility. The
results were recorded in the following figure 4.16
4.5.6 Length in service
The researcher sought to establish the duration of service. The results were recorded in the
following figure 4.16
Figure 4:16 Length in service
Less than 1 year 1-5 years 6-10 years Over 10 years
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
23%
45%
12%
20%
The results above shows that (n=92)23% of the respondents had worked for less than 1 year,
(n=180)45% had worked for between 1 to 5 years, (n=48)12% had worked for between 6 to
10 years while (n=80)20% had worked for over 10 years. The length of service of the
respondents was ideal since they could understand the effect of leadership on retention of
employees.
In reference to (Michael 2008) the maintenance of good representatives' issues for three
legitimate primary concern reasons; 1) the developing significance of scholarly capital 2) a
78
causal connection between worker residency and consumer loyalty 3) the high cost of
business turnover coherence of aggressive merchandise and ventures is guaranteed". In the
present bellicose condition the pioneers need to move their associations in the aggressive
business condition. They will climate the test on the off chance that they esteem
representatives as resources and as the ones to give their associations the upper hand. This
upper hand will be ensured if the center workers are held for whatever length of time that
conceivable with the goal that progression of focused products and enterprises is guaranteed.
4.5.7 Direct Supervisor
The researcher had to find out the duration the respondents had been working under their
direct supervisor. The results were represented in figure 4.14.
Figure 4:17 Direct Supervisor
Under 1 year 1 to 2 years 3 to 5 years 6 to 10 years Over 10
years
0%
5%
10%
15%
20%
25%
30%
35% 29%
35%
24%
12%
0%
The study above shows that (n=116)29% of the respondents had worked under their
supervisor for under one year, (n=140)35% had worked for between 1 to 2 years,
(n=96)24% had worked for 3 to 5 years, (n=48)12% had worked for between 6 to 10 years
while none had worked for over 10 years.
4.6 Assessment of Types of Leadership
The preceding section contains response about leadership styles.
79
Table 4:14 Transformational Leadership Styles
Statement SA
N (%)
A
N (%)
N
N (%)
D
N (%)
Mean SD
The employer goes beyond self-interest for the
good of the group.
80(20)
180
(45)
64
(16)
80 (20) 4.236 .231
The employer consider the moral and ethical
consequences of decisions
240 (60) 116(29) 40(10) 0 5.321 .021
The employer talks optimistically about the
future.
80 (20) 164
(41)
104(26)
32
(8%)
3.214 .147
The employer re-examines critical assumptions
to question whether they are appropriate.
104(26) 188
(47)
80 (20) 16 (4) 4.231 .321
The employer helps others to develop their
strengths.
124(31) 180
(45)
48(12) 48
(12)
4.231 .652
When there are differences in role expectations,
the employer work with them to resolve the
differences.
124 (31) 140(35) 88 (22) 32(8) 5.231 .230
The above leadership style affect my work and
intention to stay
64 (16) 148(37) 116(29) 32 (8) 4.231 .301
Effectiveness of transformational leadership 64(16) 116
(29)
180(45) 16 (4) 3.210 .214
The study above shows that (n=260)65% agreed, (n=64) 16% were neutral while (n=80)
20%disagreed that the employer goes beyond self-interest for the good of the group. Further,
(n=356)89% agreed, (n=40) 10% were neutral while (n=16) 4% disagreed that the employer
considers the moral and ethical consequences of decisions. On the other hand, (n=244)61%
agreed, (n=104)26% were neutral while (n=32) 8% disagreed that the employer talks
optimistically about the future. Moreover, 73% agreed, 20% were neutral, (n=16) 4%
disagreed that the employer re-examines critical assumptions to question whether they are
appropriate.
These discoveries were in accordance with Bass and Avolio, (2000) who contends that the
pioneer enables supporters through a mutual vision, trust and basic esteems, rousing their
impact crosswise over systems. By differentiate value-based model of administration offers
motivation based trade between the pioneer and adherent as an end-result of upgraded
execution. This approach is assignment engaged, in light of chain of command, sidesteps the
80
necessity to draw in individual and concerns upkeep and checking a previous administration,
having an operational as opposed to a key core interest.
Table 4:15 Transactional Leadership Styles
Statement SA
N (%)
A
N(%)
N
N(%)
D
N (%)
Mean SD
N (%)
The employer makes clear what one can expect to
receive when performance goals are achieved.
188
(47)
116
(29)
64(16
)
16 (4) 3.211 .302
The employer keeps track of all mistakes. 148
(37)
156
(39)
48(12
)
48(12) 4.236 .201
The employer asks for employee ideas and input
into upcoming plans and projects.
116
(29)
180
(45)
32 (8) 32 (8) 5.214 .365
The employer likes to share my leadership power
with my subordinates.
148
(37)
116(29)
72(18
)
64(16) 4.256 .214
The employer allows my employ to determine
what needs to be done and how to do it.
132
(33)
204
(51)
48(12
)
0 3.210 .201
The employer asks employees for their vision of
where they see their jobs going and then use their
vision where appropriate.
96
(24)
212(53) 48
(12)
32
(8)
3.214 .147
The above leadership style affect my work and
intention to stay
140
(35)
140
(35)
104
(26) 16
(4)
4.231 .698
Do you think, Transactional leadership style is
good?
72
(18)
196
(49)
88
(22) 48
(12)
5.236 .327
The study above indicates that (n=188) 47% agreed, (n=64) 16% were neutral, (n=16) 4%
disagreed that the employer makes clear what one can expect to receive when performance
goals are achieved. The study further indicated that (n=148) 37% agreed, (n=48) 12% were
neutral while (n=48) 12% disagreed that the employer keeps track of all mistakes. Further,
(n=116) 29% agreed, (n=32) 8% were neutral, (n=40) 10% disagreed that the employer asks
for employee ideas and input into upcoming plans and projects.
Moreover, (n=148) 37% agreed, (n=72) 18% were neutral while (n=64) 16% disagreed that
the employer likes to share my leadership power with my subordinates.These findings were
in line with (Darling, 2002); value-based pioneers are experts at controlling assets, methods
and schedules. They are guardians of the present state of affairs (Warburton, 2007) who
81
think as far as logic, with an attention on control and responsibility (Bennis, 2010). These
pioneers identify with different performing artists in part terms and support dependability,
congruity, coordination and cooperation (Fairholm, 2000). They incline toward security and
are successful in circumstances where they can coordinate the coveted conduct, control
deviation from set standards, and rebuff unmanageability (Zemke, 2009).
Table 4:16 Democratic Leadership Styles
Statement SA
N (%)
A
N(%)
N
N(%)
D
N(%)
Mean SD
Your Leader asks for the ideas of employees
for up-coming plans and project.
112
(28)
172
(43)
40(10
)
64
(16)
4.236 .234
Your leader allows you to determine what
needs to be done and how to do it in your
assignment.
96
(24)
148
(37)
112
(28) 32
(8)
5.231 .654
About any matter/decision, suggestions of
the employees are also considered
64
(16)
220
(55)
72
(18) 32
(8)
4.236 .985
Your leader create an environment where the
employees take ownership of the project and
he/she allows you to participate in the
80
(20)
116
(29)
104(26
)
72)
(18)
5.231 .201
Whenever there is difference in expectation
your leader works with you to resolve it.
80
(20)
164
(41)
104
(26) 32
(8)
5.123 .365
Employees always vote whenever a major
decision has to be made
124
(31)
180
(45)
48(12
)
48
(12)
4.235 .965
The above leadership style affect my work
and intention to stay
104(26
)
188
(47)
80
(20)
16
(4)
3.236 .247
The examination above uncovers that (n=172) 43% concurred, (n=40) 10%were unbiased
while (n=64) 20%disagreed that their pioneer requests the thoughts of representatives for
up-coming designs and venture. Then again, (n=148) 37% concurred, (n=112) 28% were
nonpartisan, (n=32) 8% disagreed that their pioneer enables you to figure out what should be
done and how to do it in your task. Further, (n=220) 55% concurred, (n=72) 18% were
unbiased while (n=32) 8% differ that about any issue/choice, proposals of the workers are
additionally considered.
These discoveries can be likened to Muzaasi, (2000) who sets that the supporters are urged
to partake and no activity without their comfort may happen or the choice may just be taken
82
after meeting. He additionally takes note of that the support of the gathering and the pioneer
in definition of approaches that fills in as rules for hierarchical operations. Choices are made
after counsel with different individuals in the association. Pioneer infers his power and
power from his supporters. People are made to feel vital and part of the association.
Table 4:17 Laissez-Faire / Passive/Avoidant Leadership Styles
Statement SA
N (%)
A
N (%)
N
N (%)
D
N (%)
Mean SD
The employer waits for things to go
wrong before taking action.
80 (20) 180 (45) 64(16) 80 (20) 5.231 .321
The employer avoids making
decisions when confronted with
issues.
240 (60) 116 (29) 40(10) 0 3.210 .547
The employer allows employees can
lead themselves just as well as I can.
80 (20) 164 (41) 104 (26) 32 (8) 4.365 .985
The employer allows employees to
set priorities with my guidance.
132 (33) 204 (51) 48(12) 0 5.214 .324
The employer allows workers know
more about their jobs than me, so I
allow them to carry out the decisions
96 (24) 212 (53) 48(12) 32
(8)
4.236 .478
The above leadership style affect my
work and intention to stay
124 (31) 180 (45) 48(12) 48 (12) 5.234 .324
Do you think, Laissez-Faire
leadership style is good?
104(26) 188 (47) 80 (20) 16 (4) 4.235 .214
The study above shows that (n=180) 45% of the respondents agreed, (n=64) 16% were
neutral while (n=80) 20% disagreed that the employer waits for things to go wrong before
taking action. On the other hand, (n=240) 60% agreed, (n=40) 10% were neutral, (n=16) 4%
disagreed that the employer avoids making decisions when confronted with issues. Further,
the study revealed that (n=212) 53% agreed, (n=96) 24% were neutral, (n=48) 12%
disagreed that the employer allows employees can lead themselves just as well as they can.
These findings were in line with Miskel and Hoy (2000) who observes that this leadership
avoids expressing their views or taking action on important issues. The leadership ignores
responsibility, provides no feedback and allows authority to remain dormant. This style is
83
regarded as the least effective, which represent absence of avoidance of leadership. members
in Laissez-faire group progressed haphazardly and took more time in arguments and
discussion mostly on purely personal basis.
Table 4:18 Autocratic & dictatorship style
Statement SA
N(%)
A
N (%)
N
N(%)
D
N(%)
Mean SD
Employees are threatened or punished if they do
wrong or mistakes have done by them in order to
achieve organization goals.
188 (47) 116 (29) 64(16) 16 (4) 5.231 .321
Your leader likes the power that he/she holds
over his/her subordinates
148 (37) 156 (39) 48(12) 48 (12) 5.321 .214
The employer always retains the final decision-
making authority within my department or team.
140 (35) 140 (35) 104 (26) 16
(4)
4.231 .369
The employer does not consider suggestions
made by my employees as I do not have the time
for them.
96 (24) 212 (53) 48
(12)
32 (8) 4.321 .453
The employer like the power that my leadership
position holds over subordinates.
148 (37) 116 (29) 72(18) 64 (16) 3.234 .341
The above leadership style affect my work and
intention to stay
132 (33) 204 (51) 48(12) 0 4.265 .621
Do you think, autocratic leadership style is good? 132 (33) 204 (51) 48(12) 0 3.200 .412
Employees are threatened or punished if they do
wrong or mistakes have done by them in order to
achieve organization goals.
124 (31) 180 (45) 48(12) 48 (12) 2.412 .321
Your leader likes the power that he/she holds
over his/her subordinates
116 (29) 180 (45) 32 (8) 32 (8) 3.214 .652
The investigation above demonstrates that (n=188) 47% concurred, (n=64) 16% were
unbiased, (n=16) 4% differ that representatives are debilitated or rebuffed on the off chance
that they foul up or botches have done by them with a specific end goal to accomplish
association objectives. Further, (n=148) 37% concurred, (n=48) 12% were unbiased, (n=48)
12% differ that their pioneer prefers the power that he/she holds over his/her subordinates.
In addition, (n=140) 35% concurred, (n=104) 26% were impartial (n=16) 4% differ that the
business dependably holds a ultimate conclusion making specialist inside my area of
expertise or group.
84
These discoveries can be adjusted to Gordon (2013) who sets that those workers under
absolutist authority style are required to take after the requests of their chief regardless of
the possibility that they don't concur or don't get any clarification underpins this position.
She contended that keeping in mind the end goal to persuade representatives, administrators
utilizing dictatorial authority styles regularly utilize an arrangement of prizes and disciplines
that are very organized.
4.7 Leadership Qualities
The researcher sought to establish skill level that the respondents’ health care manager
possessed. The results were recorded in the following table 4.16
Table 4:19 LeadershipQualities
Statement SA
N (%)
A
N (%)
N
N (%)
D
N (%)
Mean SD
N (%)
Understands and utilizes present
technology and maximizes technology as
resource for the team
212(53) 116
(29)
72 (18) 32 (8) 2.321 .322
Teamwork: ability to lead teams and be a
team member who can share work and
leadership.
48
(12)
72 (18) 112 (28) 40 (10) 3.210 .654
Never been on a team 96 (24) 172
(43)
64 (16) 32 (8) 3.214 .354
Been in a directive working group 40
(10)
172
(43)
72 (18) 16 (4) 4.231 .652
Been on a team as a team member but
never shared leadership
40
(10)
116
(29)
72 (18) 16 (4) 5.236 .374
The study above shows that (n=260)65% of the respondents agreed, (n=64) 16% were
neutral while (n=80) 20% disagreed that their leaders had the ability to influence ability to
move others to act in a desired way. Further, (n=356)89% agreed, (n=40) 10%) were neutral
while (n=16, 4%) disagreed that they actively attempts to sway others through direct
commands to act in a desired way. Further, (n=244)61% agreed, (n=104) 26% were neutral
while (n=56)14% disagreed that they are open to other ideas and listens actively to others
85
before directing them to act in a desired way. On the other hand, (n=304)73% agreed,
(n=80) 20% were neutral while (n=32)16% disagreed that they coaches others in desired
ways to act. Moreover, (n=304)76% agreed, (n=48) 12% were neutral while (n=48) 12%
disagreed that they influences others by acting in desired way themselves and delegates
work in an organized manner that allows others to act in a desired way.These findings were
in line with Smallwood (2000) who emphasized that the practical aspects of competencies in
their depiction of an administration mark. The creators expressed that capabilities are an
essential instrument for authority improvement since they give guidance to representatives,
are quantifiable, can be learned, and may help incorporate administration rehearses. By and
large, the skills may help make an administration mark and separate the association's nature
of administration.
4.8 Perception of Leadership at Health Facility
The researcher had to establish perception of leadership at health facility. The results were
recorded in the following table 4.11
Table 4:20 Perception of Leadership at Health Facility
Statement SA
N (%)
A
N (%)
N
N (%)
D
N (%)
Leadership positions are political 80 (20) 116 (29) 104(26) 72(18)
Leadership is not proactive 32 (8) 116(29) 188(47) 48(12)
Leadership performance is below par 48 (12) 204(51) 116(29) 32
(8)
Leadership exhibits weak human
relationship
80 (20) 180(45) 88 (22) 40(10)
The study above shows that (n=196)49% agreed, (n=104) 26%were neutral while (n=72)
18%disagreed that leadership positions are political. On the other hand, (n=148)37% agreed,
86
(n=188) 47% were neutral while (n=48) 12% disagreed that leadership is not proactive.
Further, (n=252)37% agreed, (n=116) 29% were neutral while (n=32) 8% disagreed that
leadership performance is below par. Finally, (n=260)65% agreed, (n=88) 22% were neutral
while (n=40) 10% disagreed that leadership exhibits weak human relationship. Medicinal
services heads are frequently required to keep up and create proficient models, strategies,
and approaches for different institutional exercises. These social insurance pioneers are
likewise in charge of creating and growing projects for logical research, preventive
pharmaceutical, therapeutic and professional restoration, and group wellbeing and welfare.
4.8.1 Perception of Leadership
The researcher sought to establish the perception of leadership affect their stay at Health
facility. The results were recorded in the following table 4.21
Table4:21 Perception of Leadership
Statement SA
N (%)
A
N (%)
N
N (%)
D
N (%)
a) I am largely not motivated 60 (15) 116 (9) 124(31) 72(18)
b) My initiative is affected 40 (10) 108(27) 188 (47) 48(12)
c) My performance is affected 52 (13) 100(26) 160(40) 40(10)
d) I do not relate well with leadership 64 (16) 220(55) 72 (18) 32 (8)
The study above shows that (n=176)44% agreed, (n=124) 31% were neutral while (n=72)
18% disagreed that they are largely not motivated. On the other hand, (n=148)37% agreed,
(n=188) 47%were neutral while (n=48) 12% disagreed that their initiative is affected.
Moreover, (n=152)38% agreed, (n=160) 40% were neutral while (n=40) 10% disagreed that
their performance is affected. Finally, (284)71% agreed, (n=72) 18% were neutral while
(n=32) 8% disagreed that they do not relate well with leadership.
87
Some therapeutically prepared wellbeing administrations administrators represent
considerable authority in territories, for example, nursing or exercise based recuperation,
and their obligations may include quiet care, and also administration capacities. Most are
utilized by clinics, however some wellbeing administrations administrators work for
specialists' workplaces, nursing care offices and medicinal services administration
associations.
4.8.2 Desired type of leadership
The researcher had to establish how the respondents would want to see leadership at Health
facility. The results were recorded in the following table 4.22
Table 4:22 Perception of Leadership
Statement SA
N (%)
A
N(%)
N
N(%)
D
N(%)
a) Appointment of leadership is based on competence 80
(20)
180
(45)
4 (1) 32
(8)
b) Leadership relates well with their employees 140 (35) 92 (23) 96(24) 64(16)
c) Staff be involved in choosing their leader 132
(33)
204
(51)
48
(15)
0
The study above shows that (n=260)65% agreed, (n=4) 1% were neutral while (n=32) 8%
disagreed that appointment of leadership is based on competence. Further, (n=232)58%
agreed, (n=96) 24% were neutral while (n=64) 16% disagreed that their leadership relates
well with their employees. Finally, (n=336)84% agreed, (n=48) 12% were neutral while
none disagreed that staff be involved in choosing their leader. The outcomes demonstrate
that clumsy initiative outcomes in poor worker execution, high anxiety, low employment
duty, low occupation fulfillment and turnover expectation. Research led on the province of
South African Training industry demonstrated that administration style was the most
noticeable maintenance factor in South Africa.
88
In reference to Taylor (2004) see, associations can never again respect leave the duty
regarding keeping great performing workers in the hands of the HR Department. Duty and
responsibility for holding ability need to move out to the forefronts and under the control of
pioneers. Pioneers and their expertise in building an atmosphere of maintenance, a culture
that addresses representatives in a way that urges them to stay, will be an association's best
safeguard against undesirable turnover. Pioneers are consequently the mystery weapon in
keeping esteemed ability longer. A two way correspondence is viewed as a center
administration competency and a key administration obligation. Pioneers ought to receive a
style that would build up and affirm their administration specialist by methods for seeming
equipped and dependable.
Table4:23Desired type of leadership
Occasionally
N (%)
Seldom
N (%)
Never
N (%)
Always
N (%)
Frequently
N (%)
1 Does a leader have a
personal interaction with
every team member?
148 (37) 116
(29)
72
(18)
64
(16)
0
2 Does the leader encourage or
plan any team outing outside
office hours?
116(29) 188
(47)
72 (18) 0 16(4)
3 How often does the team go
out on team outings?
112 (26) 172
(43)
40
(10)
64
(16)
16 (4)
4 Is your leader successful in
handling the weak members
of the team?
96(24) 148
(37)
112(28) 32
(8)
16(4)
5 Do the ideas incorporated by
the team leader help in
achieving health facility
goal?
64(16) 220
(55)
72
(18) 32 (8) 16(4)
6 Did you ever notice your
leader shouting at any team
member
80(20) 116
(29)
104(26) 72
(18)
32
(8)
7 Does the leader provide
coaching or arrange for
training if working procedure
needs to be revised?
32(8) 116
(29)
188(47) 48 (12) 16 4
89
The study above shows that (n=116) 29% of the respondents occasionally agreed, (n=116)
29% seldom agreed, (n=72) 18% were for never, (n=64) 16% indicated always while none
frequently that a. leader have a personal interaction with every team member. On the other
hand, (n=172) 43% were for occasional, (n=40) 10% were for seldom, (n=64) 16% were for
never while (n=16) 4% indicated frequently that the leader encourage or plan any team
outing outside office hours. Further, (n=148) 37% were for occasional, (n=112) 28% were
for seldom, (n=32) 8% were for never while (n=16) 4% were for frequently that the team go
out on team outings. These discoveries were in accordance with Ngodo (2008) who contend
that workers will probably stay with an association in the event that they conviction that
their directors demonstrate intrigue and worry for them, on the off chance that they realize
what is anticipated from them, in the event that they are given a part that fits their capacities
and in the event that they get consistent positive input and acknowledgment. The nature of
relationship a worker has with his or her prompt directors stretches representative remain in
an association.
4.9 Reason for retrenchment
Many medical attendants despondent with their picked calling find that employment
versatility from the bedside is troublesome without an extra degree. A nursing degree
overqualified numerous from different occupations outside of nursing and may not pay what
might as well be called a medical caretaker's present compensation. This is a give up that
some will most likely be unable to make, given that backpedaling to class requires time far
from work. Respondents trust medical caretakers depart in light of the fact that they
encounter burnout. "It's not a vocation for everybody. It takes a unique kind of individual to
deal with the passionate and physical anxiety that joins nursing," she says. "I know I won't
90
have the capacity to do bedside nursing always; the extend periods of time and stress will
begin to wear more on me.” Majority of the recommended democratic leadership.
Table 4:24Leadership Style
Statement Yes
N(%)
NoN(%)
Do you think, money can retain the staff 280(70) 120(30)
Do think staff retention is mostly affected by leadership style 276(69) 124(31)
Do you like to go to your job 324(81) 76 (19)
Do you think about the betterment of your organization and share your ideas
with your leader?
340(85) 60
(15)
Do you think about the betterment of your organization and share your ideas
with your leader?
360(90) 40
(10)
Do you feel that you are a part of the organization and for its betterment you
can take spot decisions?
348(87) 52 (13)
Do you have liberty to exercise your decisions to fulfill your commitments? 312(78) 88 (22)
Do you feel sick/uneasy/threatened while doing your jobs? 280(70) 120(30)
Do you like to do extra time to your job so that your assignments can be
finished early/in time?
272
(68)
128(32)
Can you talk freely about any matter to your leader? 232958) 168(42)
Do you think that you will never change this job? 252(63) 148(37)
The study above shows that on whether money can retain the staff, the respondents agreed
with (n=280) 70% while (n=120) 30% disagreed. Further, (n=276) 69% agreed while
(n=124) 31% disagreed that they think staff retention is mostly affected by leadership
disagreed that they like to go to their job.
It ought to be noted here that the authority style of a supervisor might be among (if not the
fundamental) stressors. A chief is the main impression of the association in the 85%)
advancement you can take spot choices. In addition, (n=312) 78% concurred while (n=88)
22%) differ that they have freedom to practice your duties. Then again, (n=280) 70%)
concurred while (n=120) 30% differ that they feel wiped out/uneasy/debilitated while doing
91
your employments. Further, (n=272) 68% concurred while (n=128) 32% differ that they
jump at the chance to do additional opportunity to your employment with the goal that your
assignments can be done right on time/in time. Besides, (n=232) 58% concurred while
(n=168) 42% differ that they speak unreservedly about any issue to your pioneer. At long
last, (n=252) 63%) concurred while (n=148) 37% differ that they felt that you will never
show signs of change this employment.
These revelations were as demonstrated by Taylor (2004), affiliations can never again
remain to leave the commitment with respect to keeping wellperforming agents in the hands
of the HR Department. Commitment and obligation regarding holding capacity need to
move out to the front lines and under the control of pioneers. Pioneers and their capacity in
building a climate of upkeep, a culture that tends to agents in a way that urges them to stay,
will be an affiliation's best make preparations for undesirable turnover. Pioneers are thusly
the puzzle weapon in keeping regarded capacity longer. A two way correspondence is seen
as a middle organization competency and a key organization responsibility. Leaders should
grasp a style that would set up and confirm their drive master by techniques for appearing to
be talented and reliable. Effective pioneers should guide people in a way that empowers
them to add to the achievement of the social event' general goal (Mat, 2008).
4.11 Level of current staff turnover
The researcher had to establish the level of current staff turnover (according to percentage of
strategies implemented within timeframe provided in strategy document). The results were
recorded in the following figure 4.15.
Figure 4:15 Level of current staff turnover
92
Less than 40% 41-70% of staff 71% and more
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
35%
42%
23%
The results above indicates that (n=140)35% of the respondents had a staff turnover of less
than (n=168) 40% on the other hand, (n=92)42% had a staff turnover.
From the study above, it is clear that the level of current staff turnover is moderate (41-
70)%. This is an indication that leadership styles have largely affected staff retention at the
health facility.
These discoveries were in accordance with Gwavuya (2011) confirms that bumbling
authority brings about poor worker execution, high anxiety, low occupation responsibility,
low employment fulfillment and turnover aim. Research led on the territory of South
African Training industry demonstrated that administration style was the most noticeable
maintenance factor in South Africa (Netswera, 2005). Sherman etal (2006) found in their
examination that larger part of the representatives in associations overviewed wanted to stay
with their associations in any event for the following five years on account of the common
culture of administration mind. Bite (2004) watched that administration conduct affects
authoritative duty and turnover goal.
93
4.12 Inferential statistics
4.4.1 There is relationship between role of leadership on retention of health workers in
public health facilities
The study carried out linear correlation analysis for the null hypothesis that there is no
relationship between roles of leadership on retention of human resources for health in public
health facilities. The findings were as indicated in Table 4.25.
Table4:25 Relationship between leadership on retention of health workers in public
health facilities
Variable Retention of health
workers
Leadership competencies Pearson Correlation
Sig. (2-tailed)
N
0.629
0.000
43
Types of leadership Pearson Correlation
Sig. (2-tailed)
N
0.601
0.013
43
Leadership qualities Pearson Correlation
Sig. (2-tailed)
N
0.533
0.023
43
The study results show that leadership competencies have a positive statistical significance
(Pearson correlation coefficient r=.629; P<0.001) with retention of human resources for
health in public health facilities. In addition, types of leadership styles were statically
significant (Pearson correlation coefficient r=.601; P<0.013) on retention of human
resources for health in public health facilities. However leadership competencies were not
significant.
Table 4:26 Model's Goodness of Fit Statistics
R R Square
Adjusted R
Square
Std. Error of
the Estimate Durbin-Watson
.734a.539 .503 .1752 1.421
94
a. Predictors: (Constant), Leadership competencies, types of leadership and leadership
qualities
These disclosures were as per Gwavuya (2011) affirms that blundering expert realizes poor
specialist execution, high tension, low occupation duty, low work satisfaction and turnover
point. Research drove on the region of South African Training industry exhibited that
organization style was the most recognizable support factor in South Africa (Netswera,
2005). Sherman etal (2006) found in their examination that bigger piece of the agents in
affiliations diagramed needed to remain with their relationship in any occasion for the
accompanying five years by virtue of the normal culture of organization mind. Nibble
(2004) watched that organization direct influences definitive obligation and turnover
objective.
Table 4:27 Analysis of Variance (ANOVA)
Model
Sum of
Squares df Mean Square F Sig.
1 Regression 2.164 4 .541 11.657 .039a
Residual 9.775 115 .085
Total 11.939 119
a. Predictors: (Constant), Leadership competencies, types of leadership and leadership
qualities
b. Dependent Variable: Employee retention
The ANOVA measurements introduced in the table above was utilized to show the relapse
demonstrate noteworthiness. A F-hugeness estimation of p = 0.039 was set up
demonstrating that there is a likelihood of 3.9% of the relapse display introducing a false
data. Along these lines, the model is huge.
95
Table 4:28 Regression Coefficients
Model
Unstandardized
Coefficients
Standardized
Coefficients
t Sig.B Std. Error Beta
(Constant) 3.544 .425 8.545 .045
Leadership competencies .541 .154 .656 5.574 .035
Types of leadership .644 .874 .241 2.486 .049
Leadership qualities .148 .441 .282 1.031 .038
Y= Employee retention
X1= Leadership competencies
X2 = Types of leadership
X3 = Leadership qualities
Y= 3.544 + 0.541X1 + 0.644X2 + 0.148X3 + 0.504X4P=0.039a
The following regression result was obtained: From the model, when other factors
(Leadership competencies, types of leadership and leadership qualities) are at zero, the
Leadership competencies will be 3.544. Holding other factors constant, a unit increase in
types of leadership would lead to 0.541 (P<.035) increase in employee retention. However,
holding other factors constant, a unit increase leadership qualities would lead to a 0.644
(P<.049) increase in employee retention. The findings can be equated to Gibson (1998) that
transformational initiative that is basic in confronting the present difficulties won't be
substance to kick back and let the journey control do the driving. These pioneers will be
looking forward, checking the scene, viewing the opposition, spotting rising patterns and
new open doors, abstaining from approaching emergency. They will be travelers, globe-
trotters, pioneers.
96
Table 4.29: Chi-Square Test: two-sample assuming equal variances
Role of Leadership Employee retention
Mean 0.046316333 0.051651083
Variance 0.00101648 0.002642089
Observations 9 12
Hypothesized Mean Difference 0 D
Df 18 D
t Stat -0.292291459 D
P(T<=t) one-tail 0.386703063 D
t Critical one-tail 1.734063592 D
P(T<=t) two-tail 0.773406127 D
t Critical two-tail 2.100922037 D
The t-test result from table 4.8 demonstrates that part of administration recorded a mean of
0.04631 while worker maintenance recorded a mean of 0.05165. Moreover, the changes of
0.0010 and 0.0026 were recorded for part of authority and representative maintenance
individually. At two-followed, the t-computed of - 0.2922 apparently is not as much as the t-
arranged of 2.1009.
97
CHAPTER FIVE: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
5.1 Introduction
The preceding entails the discussion, conclude and recommendations from the research
findings.
Summary of Finding
5.2.1 Leadership competencies of health care managers influence retention of health
workers in Meru County
The specialist looked to build up the view of the respondents on the connection between
initiative competencies of human services directors on maintenance of wellbeing workforce
in these general wellbeing offices. The respondents showed that few expert associations
have created official proclamations tending to the national nursing lack and high turnover
rate among staff medical caretakers. Detailed healing centers that have effectively enrolled
and held staff medical attendants have pioneers who showed competency in their part, are
dependable, and esteem and bolster the commitments of their representatives. These
discoveries were in accordance with Bass and Avolio, (2000) who contends that the pioneer
engages supporters through a mutual vision, trust and basic esteems, moving their impact
crosswise over systems. By differentiate value-based model of authority offers motivating
force based trade between the pioneer and supporter as a byproduct of improved execution.
This approach is errand engaged, in view of order, sidesteps the prerequisite to connect with
individual and concerns support and checking a prior administration, having an operational
as opposed to a key core interest.
5.2.2 The types leadership styles influence retention of health workers in Meru County
The study indicated that leadership styles influence retention of health workers as supported
by (n=280) 70%. These findings thus suggest that there isneed for health in public health
facilities in Meru County to look into theaspects of leadership styles, work environment and
98
working life balance practices, investment, execution administration and enrollment among
others and set up components that would address these practices and in this manner limit
their negative consequences for staff fulfillment and duty thus execution and maintenance in
the social insurance organizations in the province.
5.2.3 Leadership qualities of health care managers influence on retention of health workers in
Meru County.
The investigation uncovers that (n=304) 76% that authority qualities impacts others by
acting in wanted way themselves and representatives work in a sorted out way that enables
others to act desiredly. These discoveries were in accordance with Smallwood (2000) who
underscored that the functional parts of characteristics in their portrayal of an administration
mark. The creators expressed that qualities are a vital device for administration
improvement since they give guidance to workers, are quantifiable, can be learned, and may
help coordinate administration hones. By and large, the qualities may help make an
administration mark and separate the association's nature of administration.
Conclusions
5.2.3 Leadership competencies of health care managers influence retention of health
workers in Meru County
By characterizing work parts and related competency capability, initiative can promptly
recognize qualities and expertise holes. Competency administration at that point illuminates
focused on abilities improvement learning arrangements enhancing individual and
authoritative execution, prompting better business comes about.
5.2.4 The types leadership styles influence retention of health workers in Meru County
Authority styles impact maintenance of wellbeing specialists in Meru County. Consequently,
pioneers and their aptitude in building an atmosphere of maintenance, a culture that addresses
99
representatives in a way that urges them to stay, will be an association's best safeguard against
undesirable turnover.
5.3.3 Leadership qualities of health care managers influence on retention of health workers in
Meru County.
Initiative characteristics of medicinal services administrators’ impact on maintenance of
wellbeing laborers in Meru County. Initiative quality is a vital device for authority
advancement since they give guidance to representatives, are quantifiable, can be learned,
and may help incorporate administration hones.
Recommendations
5.2.5 Leadership competencies of health care managers influence retention of health
workers in Meru County
To improve their capabilities, Leaders ought to give work-life adjust; give staff far reaching
restorative covers or access to free treatment and childcare administrations.
5.2.6 The types leadership styles influence retention of health workers in Meru County
To enhance their abilities, Leaders should give work-life modify; give staff sweeping
helpful covers or access to free treatment and childcare organizations.
5.3.3 Leadership qualities of health care managers influence on retention of health workers in
Meru County.
Giving more streets to interest in fundamental initiative and general correspondence will
engage the staff to give their commitments to methodologies and goals of the affiliation.
Empower it will open strategies for perceiving issues affecting staff that that if left
unattended may affect them to take off. The pioneers should be open to staff issues since
responding to staff issues rapidly exhibits that the pioneers care and this reason plan to stay
longer in the affiliation.
100
REFERENCES
Abbasi, S. M. and K.W. Hollman (2000), ‘Turnover: The Real Bottom Line,’ Public
Personnel Management, 29(3), 333.
Alan, M. (2013).Leadership Styles. (Online: http//www.ofd.ncsu.edu/wp-content
/leadership). Retrieved April 4,2015.
Ali, H., Ismael, A., Mohamed, S. and Davoud, N. (2011).The impact of Responsibility and
Leadership Styles on Leading Change Capability of Malaysian Managers.Australian
Journal of Business and Management Research, 1 (2), 70-98.
Antonio Mussa, 2007, Africa Health Monitor January – June 2007. Vol. 7, No1.A magazine
of the World Health Organization Regional Office for Africa.
Atwater, L. E., & Bass, B.M (2004). Does self-other agreement on leadership perceptions
moderate the validity of leadership and performance predictions? Personnel
Psychology, 45, 141−164.
Atwater, L. E., Ostroff, C., Yammarino, F. J., & Bass, B.M. (201). Self-other agreement:
Does it really matter? Personnel Psychology, 51, 577−598.
Atwater, L., & Bass, B.M. (2009).Leader–member exchange, feelings of energy, and
involvement in creative work.Leadership Quarterly, 20, 264−275.
Bass, B. M. &Riggio, B.J. (2009). Developing transformational leadership: 1 992 and
beyond. Journal of European Industrial Training, 14, 2 1-27.
Bass, B. M. (2008). Bass and Stodgill's handbook of leadership.New York Free Press.
Bass, B.M. &Avolio B.J (2000).The Future of Leadership in Leaning Organizations.Journal
of Leadership and Organizational Studies, 7 (3), 18-40.00
Bass, B.M. &Avolio, B.J. (Eds.).(1994).Improving organizational effectiveness through
transformational leadership.Thousand Oaks, CA: Sage Publications.
Bass, B.M. (1985). Leadership and performance beyond expectations. New York: Free
Press. Beard well (2007).
Beardwell J., &Claydon, T. (2007). Human Resource Management.A contemporary
Approach. London: Prentice Hall.
Bennis W. (2009). The challenge of leadership in the modern world: introduction to special
issues. Am. Psychol., 62(1), 2-5.
BECTA.(2009). A review of the research literature on barriers to the uptake of ICT by
teachers. Retrieved from: ttp://partners.becta.org.uk/page_documents/research/barriers.pdf.
101
Bennis W. (2010) "Where Have All the Leaders Gone" In Contemporary Issues In
Leadership (eds) W.E Rosenbasch and R.L.
Bite,F.T. (2004). Relationship of transformational and transactional leadership with
employee influencing strategies. Group and Organizational Studies, 13, 456-467.
Bolden, L.W. Wendy, L. (2003). The relationship between strategic leadership perception,
Boyatzis, R. E. (2008). Competencies in the 21st century.Journal of Management
Development, 27(1), 5–12.
Boyle, D.K., Bott, M.J., Hansen, H.E., Woods, C.Q. & Taunton, R.L.(2010).Managers’
leadership and critical care nurses’ intent to stay. Am J Crit Care. 1999 Nov;
8(6):361-371.
Boyle, L. P., &Bott, R. (2010).Building a democratic work group. Personnel, 22(3), 142-
148
Burns, N & Grove, S.K. 2005.The practice of nursing research: conduct, critique and
utilization. 5th edit ion. St Louis: Elsevier Saunders.
Carney, (2009) “Leadership in nursing: current and future perspectives and challenges:
editorial,” Journal of Nursing Management, vol. 17, no. 4, pp. 411–414, 2009.
Casida and J. Parker, (2011). “Staff nurse perceptions of nurse manager leadership styles
and outcomes,” Journal of Nursing Management, vol. 19, no. 4, pp. 478–486, 2011.
Casida, D. C. Parker, (2011). The achieving society. Princeton, NJ: Van Nostrand
Castillo- Laborde, C. 2011. Human resources for health and burden of disease: an
econometric approach. Human Resources for Health , 9(1): 4.
Certon, R., (2000). Authentic leadership and positive psychological capital: The mediating
role of trust at the group level of analysis. Journal of Leadership and Organizational
Studies, 15, 227–240.
Chew,J.C. (2004). The influence of human resource management practices on the retention
of core employees of Australian organisation.PhD Thesis.Murdoch University.
Chin, C. O., &Gaynier, L. P. (2006, March). Global leadership competence: A cultural
intelligence perspective. Paper presented at the 2006 Midwest Business
Administration Association International Conference. Chicago, IL.
Clavelle, J., Drenkard, K., Tullai-McGuinness, S. & Fitzpatrick, J. (2012). Transformational
leadership practices of chief nursing officers in Magnet® organizations.Journal of
Nursing Administration, 42(10), 3-9. Conger, J.A. and
Clavelle, L. P., & Hayes, R. Laschinger, (2012).Building a democratic work group.
Personnel, 22(3), 142-148.
Cochran WG (1977). Sampling Techniques, 3rd edition. New York: John Wiley & Sons.
102
Conger, D. C. Hunt, (1999).The achieving society. Princeton, NJ: Van Nostrand.
CORMACK, D. 2000. The research process in Nursing. 4th Edition, London:
Blackwell Science Ltd.
Daft,F.E, (1999). Transformational leadership, transactional leadership, locus of control, and
support for innovation: Key predictor of consolidated business-unit performance.
Journal of Applied Psychology, 78, 891-902.
Dansereau, F., Alutto, J.A., &Yammarino, F.J. (1984). Theory testing in organizational
behavior: The varient approach. Englewood Cliffs, NJ: Prentice-Hall.
Dansereau, R. J., Spangler, W. D., &Woycke, J. (1984). Personality and charisma in the
U.S. presidency: A psychological theory of leadership effectiveness. Administrative
Science Quarterly, 36, 364-396.
Darling J. R (2002); Organisational Excellence and Leadership Strategies: Principles
followed by Top Multinational Executives; Leadership and Organizational
Development Journal 20(6) Pages 309- 21.
Davison, R.B., Timo, Wang & Hollenbeck, J.R. (2010), (in press) Boundary spanning in the
domain of multiteam systems. In S.J. Zaccaro, M.A. Marks, & L.A. DeChurch
(Eds.), Multiteam systems: An organizational form for dynamic and complex
environments. New York: Taylor & Francis.
Day. D. V., & Lord, R. G. (1988). Executive leadership and organizational performance:
Suggestions for a new theory and methodology. Journal of Management, 14, 453 –
464.
Donna, C. (2011). Overcoming the Drawbacks of the Democratic Leadership Style.
(Online:http://www.brighthubpm.com/rescourse-management).
Duffield, C., Kearin, M., Johnston, J., & Leonard, J. (2007).The impact of hospital structure
and restructuring on the nursing workforce.Australian Journal of Advanced Nursing,
24, 42–46.
Duffield, C., Roche, M., Blay, N., &Stasa, H. (2011). The work environment, nursing unit
managers, and staff retention. Journal of Clinical Nursing, 20(1–2), 23–33.
Duffield, J. E., Fritz, S. M., & Marx, D. (2007).A field study of two measures of work
motivation for predicting leader's transformationalbehaviors. Psychological
Reports, 86,295-300.
Ehrhart, M.G. and Klein, K.J. (2001).Predicting Followers’ Preferences for Charismatic
Leadership: The Influence of Follower Values and Personality.The Leadership
Quarterly, 12, 153-179.
Eze, H.C. (2010).Leadership in Organization.Journal of Nigerian Institute of Management,
46 (1), 29-35.
103
Fairholm G.W (2000). Spiritual Leadership; Fulfilling Whole-self Needs at Work:
Leadership and Organisational Development 17 (5)
Farag, S. Tullai-Mcguinness, and M. K. Anthony, (2009). “Nurses' perception of their
manager's leadership style and unit climate: are there generational differences?”
Journal of Nursing Management, vol. 17, no. 1, pp. 26–34, 2009.
Fieldler, S. D., (1967). Substitutes for leadership, or not. The Leadership Quarterly, 16,
169–193.
Flippo&Musinger (2010) Consideration and initiating structure and their relationships with
leader effectiveness: A meta-analysis. Best Papers Proceedings, Academy of
Management, Anaheim, CA, pp.201-205
Gay, L. R. (1990). Educational Research(3rded.) London: Merrill Publishing Company.
Gibson R. (1998); Rethinking The Future; Nicholas Brealey Publishing, London
Glynn, J. E., &DeJordy, D. (2010). A field study examining two measures of work
motivation for predicting leaders' influence tactics used. Journal of Social
Psychology, I42(5), 601-616.
Gordon, J.R. (2013). Autocratic Leadership Style.(Online: http://www.action-
wheel.com/authocratic-leadership
Grint, S. D., (2011). Alternatives for leadership.The Leadership Periodical, 16, 169–193.
Gwauya, F. (2011).Leadership influences on turnover intentions of academic staff in
institutions in Zimbabwe .Academic Leadership Journal, 9, p. 1-15.
Hackman R. P, Wageman R (2010 ). Asking the right questions about leadership
discussion and conclusion. Psychol.,61(1), 1-41.
Hambrick, D. C.& Mason (1984), Environmental Scanning and Organizational Strategy , in:
Strategic Management Journal, 3, 159-173.
Hayes, L., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., Laschinger,
H., & North, N. (2012). Nurse turnover: a literature review – an update.
International Journal of Nursing Studies, 49, 887–905.
Heath, J. J., & Lee, B. M. (2011).Superiors' evaluations and subordinates' perceptions of
transformational and transactional leadership.Journal of Applied Psychology, 73(4),
695-702.
Hernez-Broome and Hughes (2004). Patterns of aggressive behavior in experimentally
created social climates. Journal of Social Psychology, 10, 27 1-30 1.
Hershey, R., & Blanchard, G. R., (1996). Authentic leadership and positive psychological
capital: The mediating role of trust at the group level of analysis. Journal of
Leadership and Organizational Studies, 15, 227–240
104
House RJ (2001), Personality and charisma in the US presidency: a psychological theory of
leader effectiveness. Administrative Science Quarterly. 1991;36:364–396.
House, R.J. and Howell, J.M. (1992).Personality and Charismatic Leadership.The
Leadership Quarterly, 3, 81-108.
Howell JM 2001, KLSP: Transformational Leadership, Working Paper. College Park, Md:
Academy of Leadership Press; 1997. Organization contexts, charismatic and
exchange leadership.
Howell, J.M. and Shamir, B. (2005). The Role of Followers in the Charismatic Leadership
Process: Relationships and Their Consequences. Academy of Management Review,
30 (1), 96-112.
Hsieh, W. C. (1993). Affective, Normative and Continuance Commitment: Can the
‘Right Kind’ of commitment be managed? Unpublished Working Paper for the
Department of Management, University of Melbourne.
Huber, D. L. M. Maas, J. McCloskey, C. A. Scherb, C. J. Goode, and C. Watson,
“Evaluating nursing administration instruments,” Journal of Nursing Administration,
vol. 30, no. 5, pp. 251–272, 2000.
Hunt, J. G. (1991). Leadership: A new synthesis. Newbury Park, CA: Sage.
Hunt, J.G. (1999). Charismatic and Transformational Leadership: Taking Stock of the
Present and Future. The Leadership Quarterly, 10 (2), 121-127.
Hunt, J.G., &Ropo, A. (1995). Multi-level leadership: Grounded theory and mainstream
theory applied to the case of General Motors. The Leadership Quarterly, 6, 379-412.
Huston, H. (2008) “Preparing nurse leaders for 2020,” Journal of Nursing Management, vol.
16, no. 8, pp. 905–911, 2008. View at Publisher ·
Intagliata,J.,Ulrich, D.,&Smallwood,N.(2000). Leveraging leadership competencies to
produce leadership brand: Creating distinctiveness by focusing on strategy and
results Human Resources Planning, 23(4),12–23.
Jacobs, T. O. &Jaques, E. (1987).Leadership in complex systems. In J. Zedner (Ed.), Human
productivity enhancement, (Vol. 2, pp. 1 – 65), New York: Praeger.
Jacobs, T. O., & McGee, M. L. (2001).Competitive advantage: Conceptual imperatives for
executives. In S. J. Zaccaro& R. J. Klimoski (Eds.), The nature of organizational
leadership: Understanding the performance imperatives confronting today’s leaders
(pp. 42 – 78). San Francisco, CA: Jossey-Bass.
Jago, A.G. (1982). Leadership: Perspectives in theory and research.DJournal of management
science@28(3) 315-332.
Jaepil, T. K. (2006). The effects of leadership involvement and the importance of the task on
subordinates' performance. Organizational Behavior and Human Performance, 17,
299-3 10.
105
Jeremy .M, Melinde .C & Ciller V. (2011). Perceived leadership style and employee
participation in a manufacturing company in the democratic republic of Congo,
African journal of business management, .6(15), 5389-5398.
Jossey-Bass, J. E. (2003). Taking the charisma out of transformational leadership.Journal of
Social Behavior and Personality, 12, 689- 697.
Jun, R., (2001). Authentic leadership and positive psychological capital: The mediating role
of trust at the group level of analysis. Journal of Leadership and Organizational
Studies, 15, 227–240.
Kanter R. M. (1982). The middle manager as innovator. Harvard Business Review 60: 95-
105.
Katz, D., & Kahn, R. L. (1978).The social psychology of organizations, 2nd Ed. New York,
NY: John Wiley and Sons.
Katz, R. L. (1955). Skills of an effective administrator. Harvard Business Review, 33, 33 –
42.
Katzenbach, M. A., & Smith, A. D. (2011).Reversing the extraverted leadership advantage:
The role of employee proactivity. Academy of Management Journal, 54, 528–550.
King, D. (1994). The changing shape of leadership. Educational Leadership,59(8), 61 – 63.
Kipkebut, D. J. (2010).Organizational Commitment and Job Satisfaction in Higher
Educational Institutions: The Kenyan Case.PhD thesis, Middlesex University.
Kirsch,G.H. and Lennon,C.D, (2005). Leadership in organizations. New York: Prentice
Hall.
Kooker BM, Kamikawa C. Successful strategies to improve RN retention and patient
outcomes in a large medical centre in Hawaii.Journal of Clinical Nursing.
2011;20(1-2):34–39. [Pub Med]
Krishnan, V.R. (2004).Impact of Transformational Leadership on Followers’ Influence
Strategies.Leadership and Organizational Development Journal, 25 (1),
Lall, K., &Lall, P. (2000). Transactional & transformational leadership: A constructive
developmental analysis. Academy of Management Review.12(4),-648-657.
Larsonn, G. B., &Vinberg, M. (2010). Relationship-based approach to leadership:
Development of leader–member exchange (LMX) theory of leadership over 25 years:
Applying a multi-level multi-domain perspective. The Leadership Quarterly, 6, 219–
247.
Laschinger, H., Wong, C., McMahon, L., & Kaufmann, C. (1999). Leader behaviour impact
on staff nurse empowerment, job tension, and work effectiveness. Journal of
Nursing Administration, 29(5), 28–39.
Lewin, G. B., (2009). Relationship-based approach to leadership: Development of leader–
member exchange (LMX) theory of leadership over 25 years: Applying a multi-level
multi-domain perspective. The Leadership Quarterly, 6, 219–247.
106
Lewis, S. D., Goodman, F. J., &Fandit, J. (2001).Substitutes for leadership, or not.The
Leadership Quarterly, 16, 169–193.
Marturano, D., Gosling, N., Jeremy, G., & Floor, L. (2008).Productivity, supervision, and
morale among railroad workers. Ann Arbor: University of Michigan, Institute for
Social Research.
Mat, J. (2008).The influence of leadership style on internal marketing in retailing.PhD
Thesis.University of Stirling.
McAdam, R., (2003). Leader–member exchange and citizenship behaviors: A meta-analysis.
Journal of Applied Psychology, 92, 269–277.
McDaniel, J. &Wolf, G.A. (1992).Transformational leadership in nursing service.A test of
theory. J Nurs Adm. 1992 Feb;22(2):60-5.
McNamara, C. (2003). Field guide to leadership and supervision for nonprofit staff (2nd
ed.). Minneapolis, MN: Authenticity Consulting.
Michael, A. (2008) Leadership style and organizational impact.(Retrieved
from:http//www.ala-apa.org)
Michael, A.G. (2010). Leadership Style and Organizational Impact.(Online:http://
www.ala.apa.org/newsletter). Retrieved April 10, 2015.
Mioduser, D., Nachmias, R., Tubin, D., &Forkosh-Baruch, A. 2003.Analysis schema for the
study of domains and levels of pedagogical innovation in schools using ICT.
Education and Information Technologies, 8: 23-36.
Miskel,& Hoy B. M. (2000). Intrinsic and extrinsic motivation. Morristown, NJ: Silver
Burdett.
Management Sciences for Health.(2010).Managers Who Lead: A Handbook for Improving
Health Services 3rd ed., Cambridge, MA: Management Sciences for Health.
Muindi, F. (2011).The relationship between participation in decision making and job
satisfaction among academic staff in the School of Business University of
Nairobi.Master of Business Administration Thesis, University of Nairobi.
Muzaasi, N. H., (2000). Work motivation: The incorporation of self-concept-based
processes. Human Relations, 52, 969-998.
Mukamel, D. B., Spector, W. D., Limcangco, R., Wang, Y., Feng, Z., &Mor, V. (2009). The
costs of turnover in nursing homes.Medical Care, 47(10), 1039.
Mwai, E. (2011) Creating Effective Leaders through Situational Leadership
Approach.Unpublished Bachelor’s Thesis.JAMK University of Applied Sciences.
Netswera, F.G., Rankhumise, E.M., and Mavhundila, T.R. (2005) Employee retention
factors for South African higher education institutions: A case study. South
African Journal of Human Resource Management, 3, p. 36-40.
107
Ngodo O.E (2008). Procedural justice and trust: The link in the transformational
leadership-organisational outcomes relationship. Int. J. Lead. Stud., 4(1), 82-100.
Nick Petrie, (2010) Center for Creative Leadership, Future Trends in Leadership
Development, WHITE PAPER
Northouse, P.G. (2001). Leadership Theory and Practice.Pastoral Psychology, 56 (4), 403-
411.
Northouse.,& Scholl, R. W. (1997). Leaders' sources of motivation and perceptions of
followers' motivation as predictors of leaders' influence tactics used. Psychological
Reports, 84, 1087- 1098.
O’Connor, J., Mumford, M.D., Clifton, T.C., Gessner, T.L. and Connelly, M.S. (1995).
Charismatic Leaders and Destructiveness: A Historiometric Study. The Leadership
Quarterly, 6 (4), 529-555.
O'Connell, M., & Mei-Chuan, K. (2007).The cost of employee turnover.Industrial Management,
49(1), 14-19.
Okumbe, J.M. (2000). – Educational management theory & practice.
Omolayole, J. G. (2006). Transformational/charismatic leadership's transformation of the
field: An historical essay. Leadership Quarterly, 10(2), 129-144.
Peng-Hsian, K., Hsin, K. and Thun-Yun, K. (2008). Situational Leadership Style Identified
for Taiwanese Executives in Mainland China. Journal of Engineering Technology
and Education, 5 (4), 563-576.
Pfeffer, J. (1998). Seven practices of successful organizations, California Management
Review, 40(2):96-123.
POLIT, DF and BECK, CT. 2006.Essentials of Nursing Research: Methods, appraisal and
Utilization. 6 th edition. Philadelphia: Lippincott Williams and Wilkins
Qin,T.(2011).Situational Leadership.(www.onmymind.areavoices.com /2011/10/30/situational-
leadership styles). Retrieved April 13, 2015.
Ramey, J.W., (2002).The relationship between leadership styles of nurse managers and
staff nurse job satisfaction in hospital settings. M.A. Thesis, The Graduate College
of Marshall University, Huntington, West Virginia.
Raup,(2008). “The impact of ED nurse manager leadership style on staff nurse turnover and
patient satisfaction in academic health center hospitals,” Journal of Emergency
Nursing, vol. 34, no. 5, pp. 403–409, 2008.
Rhatigan J.,Sachin Jain J. Mukherjee S. & Michael E. Porter (2009) Applying the Care
Delivery Value Chain: HIV/AIDS Care in Resource Poor Settings Joseph.
Richard, H. C. (2011). Compliance, identification, and internalization: Three processes of
attitude change. Journal of Conflict Resolution, 2, 5 1 -56.
108
Richard, P.C. (2013). Leadership is an Action, Not a Word.
(www.1000ventures.com/business_guide/crosscuttings/leadership_situational.htm.
Retrieved April 12, 2015.
Robbins, S.P. (1998).Organizational behaviour (9th Edition). New Jersey: Prentice Hall.
Rodgers, M. (2003).Relationship-based approach to leadership: Applying a multi-level
multi-domain perspective. The Leadership Quarterly, 6, 219–247.
Rotimi, O. (2013). Leadership Journal.(http://www.theleadershipjournal. Constitutional
leadership/). Retrieved March 10, 2015.
Ronald.(2011). Encyclopedia of Leadership. (http:www.Knowledge.sagepub.com).
Retrieved March 10, 2015.
Santa, M.,(2007). Leadership styles of nurse-managers: influences on commitment
[Doctoral dissertation], Stevens Institute of Technology, 2007.
Shaw, J.D., Duffy, M.K., Johnson, J.J., & Lockhart, D. (2005). Turnover, social capital
losses, and performance.Academy of Management Journal, 48, 594-606.
Sherman, V and Michael, H. (2006). Influence activates: A framework for understanding
follower obedience. Leadership Quarterly, 11, 365- 387.
Singleton, R. (1988): Approaches to Social Research. Oxford University Press, NY.
Spencer,M.V and Spencer, C.I, (1993). One more time, how do you motivate employees?
Haward Business Review, 46(1), 53-62.
Stahl,H.D and Bjorkman, (2006). Effectiveness correlates of transformational leadership: A
meta-analytic review of the MLQ literature. Leadership Quarterly, 7,3 85-425.
Stephen, F. (2013).The Dark Side of Leadership.Journal of Leadership and Organizational
Studies, 13(1), 24-43.
Stichler, J.F. (2006). Skills and competencies for today’s nurse executive. Association of
Women’s Health Obstetric and Neonatal Nurses Lifelines, 10(3), 255–257.
Stodgil, T.E. (1948). Personality and charisma presidency: A psychological theory of
leadership effectiveness. Administrative Science Quarterly, 36, 364-396.
Swarup, B. (2013). Leadership.(On-line: http://www.hrfolks.com). Retrieved April 14, 2015.
Swayen, L.E. Duncan, J.W Ginter, (2008), Strategic management of Health Care
Organisations, Blackwell Publishing Ltd., Oxford.
Tannenbanum, H. C. Schmidt, H, G.(2000). Compliance, identification, and internalization:
Three processes of attitude change. Journal of Conflict Resolution, 2, 5 1 -56.
Taunton, R.L., Boyle, D.K., Woods, C.Q., Hansen, H.E. & Bott, M.J. (2010). Manager
leadership and retention of hospital staff nurses. West J Nurs Res. 1997
Apr;19(2):205-26.
109
Taylor, J. J., (2004). Superiors' evaluations and subordinates' perceptions of
transformational and transactional leadership.Journal of Applied Psychology, 73(4),
695-702.
Thorndike, M., & Hagen, H.A. (1961).Research methods for business students. (4thed.).
Harlow: Prentice Hall, Pearson Education Limited.University of Zululand.
Upenieks, V. (2003). What constitutes effective leadership? Perceptions of Magnet and non-
Magnet nurse leaders. Nursing Administration Quarterly, 33(9), 456–457.
Uris, J. K., (2000). The effects of leadership involvement and the importance of the task on
subordinates' performance.Organizational Behavior and Human Performance, 17,
299-3 10.
Veenhof, B. J., (2005). Transformational leadership in a management game simulation.
Group & Organization Studies, 13, 59-79
Voon M.L.,Lo, K. S. Ngui and AyobN. B. (2011). The influence of leadership styles on
employees’ job satisfaction in public sector organisations in Malaysia”,
International Journal of Business, Management and Social Sciences, Vol. 2, No. 1,,
pp. 24-32, 2011.
Vroom V.H, &Jago A. G. (2007). The role of the situation in leadership. Am.
Psychol, 62(1), 17-24.
Warburton, B. (2007). Authentic leadership: Rediscovering the secrets to creating lasting
value. San Francisco, CA: Jossey-Bass
Weberg,D. (2010). “Transformational leadership and staff retention: an evidence review
with implications for healthcare systems,” Nursing Administration Quarterly, vol.
34, no. 3, pp. 246–258, 2010.
Weihrich H. and Harold K. (2009).Essentials of Management. An International Perspective,
7th Edition, New Delhi Tata MC Graw– Hill.
Weihrich, P. M., & Koontz, R. (1990). Transformational leader behaviors and their effects
on followers' trust in leader, satisfaction, and organizational citizenship behaviors.
Leadership Quarterly, 1, 107- 142.
WHO (2009). Everybody’s Business: strengthening health systems to improve health
outcomes: WHO‟s framework for action. NLM classification: W 84.3. Available at
www.who.int/healthsystems/strategy/
World Health Organization. (2007). Everybody’s Business: Strengthening Health Systems to
Improve Health Outcomes: WHO's Framework for Action. Geneva, Switzerland:
World Health Organization.
Yammarino, F. J., Dionne, S. D., Chun, J. U., &Dansereau, F. (2005). Leadership and levels
of analysis: A state-of-the-science review. The Leadership Quarterly, 16,
879 – 919.
110
Yukl, G. (2002). Leadership in organizations (3rd ed.) Upper Saddle River, NJ: Prentice
Hall.
Zaccaro, S. J (1996). Models and theories of executive leadership: A conceptual/empirical
review and integration. Alexandria, VA: U.S. Army Research Institute for the
Behavioral and Social Sciences.
Zaccaro, S. J. &Klimoski, R. (2001).The nature of organizational leadership: An
introduction. The nature of organizational leadership: Understanding the
performance imperatives confronting today’s leaders (pp. 3 – 41). San Francisco,
CA: Jossey-Bass.
Zemke R. (2009); The Gulf of Mutual Incomprehension, Training, August 8.
Zervas, C. and David, L. (2013). Leadership Style: Is there “one Best”, or is Flexibility
worth developing? www.leadershipadvantage.com/leadership. html). Retrieved April
14, 2015.
Zwell, M. (2000).Creating a culture of competence. New York, NY: Wiley.
APPENDICES
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APPENDIX 1: ETHICAL CLEARANCE
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APPENDIX 2: APPROVAL TO COLLECT DATA
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APPENDIX 3: RESEARCH AUTHORIZATION
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APPENDIX 4: CONSENT FORM
Kenya Methodist University
P. 0 Box 267-60200
Meru, Kenya
SUBJECT: INFORMED CONSENT
Dear Respondent,
My names are Leonard MbaabuKimwere-Admission Number HSM-3-1258-3/2012.I am a
Msc student from Kenya Methodist University. I am conducting a study titled: The role of
leadership on human resources retention for health in public health facilities in Meru
County, Kenya the findings will be utilized to strengthen the health systems in Kenya and
Low-in- come countries in Africa. As a result, countries, communities and individuals will
benefit from improved quality of healthcare services. This research proposal is critical to
strengthening health systems as it will generate new knowledge in this area that will inform
decision makers to make decisions that are research based.
Procedure to be followed
Participation in this study will require that I ask you some questions and also access all the
hospital’s department to address the six pillars of the health system. I will record the
information from you in a questionnaire check list.
You have the right to refuse participation in this study. You will not be penalized nor
victimized for not joining the study and your decision will not be used against you nor affect
you at your place of employment.
Please remember that participation in the study is voluntary. You may ask questions related
to the study at any time. You may refuse to respond to any questions and you may stop an
interview at any time. You may also stop being in the study at any time without any
consequences to the services you are rendering.
Discomforts and risks.
Some of the questions you will be asked are on intimate subject and may be embarrassing or
make you uncomfortable. If this happens; you may refuse to answer if you choose. You may
also stop the interview at any time. The interview may take about 40 minutes to complete.
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APPENDIX 6: MAP OF MERU COUNTY
Location, Administrative Areas and Population Densities
SOURCE: (Google Map, 2014)
The map illustrates the spatial population density patterns that also include parts of the
newly created Meru County. The County is quite densely populated but with diverse
distribution varying from one division top the other and from region to region.
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