An Exploration of Global Leadership Behavior and Job Satisfaction in Health Information Management

Abstract

Health information management (HIM) professionals are a vital component of a global network of healthcare specialists who assure quality documentation, data governance, analysis of data, and medical coding of vital healthcare statistics.¹ These healthcare professionals make up a globally diverse community² which demands leaders with globally transferable leadership skills.

The goal of this study was to explore the application of Servant Leadership Theory³ to job satisfaction through globally applicable and transferable leadership behavior. A case study approach of semi-structured interviews and blog posting entries were examined through the principles of a global mindset.^4. Results of this study are applicable to the community of practicing HIM professionals through the identification and examples of the application of effective and globally transferable leadership behavior.

Introduction

HIM professionals are a vital component of a global healthcare workforce who apply their expertise in governing and analyzing healthcare data for security, accuracy, and integrity. There are more than 200,000 HIM professionals in the United States⁵ and over 32,000 in Canada.⁶ Due to the globalization of healthcare, the outsourcing of HIM tasks has increased by 31 percent from 2011 to 2016⁷ and international companies based in the United States are hiring HIM professionals from around the world. This has spawned a mosaic of ethnicities in HIM⁸ who are at the forefront of a digital healthcare industry which has transformed from regional to global and consumed more than or $3.5 trillion, or 18 percent of GDP in 2017.⁹

It's projected the United States will see an increase of more than 6,000 HIM positions per year, yet foresee only 2,000 annual graduates from accredited HIM programs.¹⁰ In Canada, an additional 12,330 will be needed within the next few years.¹¹ The shift to a global workforce and the projected shortage of HIM professionals presents the importance of providing an organizational climate which promotes job satisfaction. When professionals compare the aspects of a job, allowances for pay and working conditions will be made, but recognition of personal and professional value won't be sacrificed.¹² Identifying globally transferable leadership skills which recognize and nurture the value of the employee is vital to the recruitment and retainment of qualified employees.

Job satisfaction is dependent on the communication and relationship¹³ between an ethical leader¹⁴ and follower. This provided the motivation to explore servant leadership theory through the application of a global leadership approach. Servant leadership behavior is comprised of conduct which “seeks to involve others in decision making, is strongly based in ethical and caring behavior and enhances the growth of workers while improving the quality of the organizational climate”¹⁵ and exhibits the behavioral traits and characteristics of serving first and leading second. Yet, within the global society of HIM professionals, exhibiting these leadership traits are not enough; leaders must be able to apply global leadership skills in an environment of global diversity.

An effective leader of HIM professionals must have the ability to motivate a group of people, constructively seek a clear vision and foster growth while working within a globally complex frame of reference.¹⁶ The ability to learn and understand at a global level (intellectual capital), the self-confidence to function in a cultural environment different from their own (psychological capital) and the ability to cultivate new relationships with individuals from diverse cultures (social capital) is crucial to serving first and leading second in global diversity.¹⁷

Due to the crucial need of globally effective leaders, this research explored the effect of servant leadership theory on job satisfaction as applied through a global mindset of leadership behaviors. Canadian participants were included due to both the United States and Canada experiencing a shortage of HIM professionals and to give the research a global perspective. The context of this qualitative research was framed within the thematic description of 10 servant leadership characteristics¹⁸ and the original servant leadership definition of, “The best test is: Do those served grow as persons; do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to be servants?”¹⁹ and the merger of global mindset characteristics²⁰ demonstrated in Table 1.

Table 1.

Servant Leadership Characteristics and Global Mindset Equivalents

Servant Leadership Behavior Characteristics	Global Mindset
1. Listening	Intellectual Capital
2. Building Community
3. Commitment to Growth
4. Foresight
5. Empathy	Psychological Capital
6. Awareness
7. Conceptualization
8. Healing	Social Capital
9. Stewardship
10. Persuasion

Note: Global Mindset Inventory Variables²¹ associated with Servant Leader Behavior Characteristics.²²

The servant leadership traits of conceptualization, persuasion, building community, commitment to growth and foresight of the future²³ were also explored through a definition of global leadership²³ shown in Table 2. Please note the original theory of servant leadership was developed in 1970, and the bulk of research following took place within the first quarter century of development. Hence, you will find research and references within this research predominately from the time period of 1970s to the mid-1990s.

Table 2.

Global Leadership Definition²⁴ Mapped to Servant Leadership Characteristics.²⁵

Description of Global Leadership Traits	Characteristics of Servant Leadership
An individual who inspires a group of people	1. Persuasion
Willing to pursue a positive vision	2. Conceptualization
Able to perform in an organized fashion	3. Building Community
Fosters individual and collective growth	4. Commitment to the Growth of People
Able to perform within an environment of complexity, flow and presence	5. Foresight

Methodology

The multiple-case study and blog entry format utilized was based on a constructivist approach²⁶ and utilized the Interactive Model of Research Design²⁷ to explore the following questions:

1. How do HIM professionals describe the experience of job satisfaction in the United States and in Canada?

2. How do HIM professionals describe their job satisfaction experiences with leaders who exhibit servant leader and global mindset behavior?

3. How do leaders describe the role they play in the job satisfaction of HIM professionals?

As seen in Figure 1, the Interactive Model of Research Design²⁸ intertwines the goal, conceptual framework, method, and validity with the research questions which allows continual assessment and comparison between each investigative component.

Figure 1.

Application of Interactive Model of Research Design²⁹

Similarities and differences were explored between participant responses from semi-structured interviews with currently employed HIM professionals in the United States and Canada and an additional cyber-artifact obtained from open forum blog entries. The use of blog entries provided a forum for anonymous participant participation and provided extensive data within a naturalistic context.³⁰ Blog entries also represented the “symbols” of the group and were used to “understand their beliefs, values, and behaviors.”³¹

Blog entries further allowed a view of the everyday life of the blogger³² with the additional ability of continuous access to data. Both participant interviews and blog entries were focused on the leader/follower perception of servant leadership, global mindset, and job satisfaction.

United States interview participants were procured from the eastern United States, while the interview participants from Canada were procured from both the eastern and western sections of northern Canada. Interview participants were chosen randomly from a request for participation from the website of three different professional organizations for HIM professionals.

Due to not knowing the number of interview participants and blog entries needed prior to beginning this qualitative/case study research, a prediction of ten participant interviews and cyber-artifacts was made. The exploration of data continued until saturation (each new unit of analysis produces very little new data) was reached³³ which resulted in conducting 11 extensive interviews. Blog entries of three HIM professional organizations were chosen for their focus population of health information professionals. Blogs were seeded (an initial post regarding general leadership behavior was posted to begin a conversation) and open forum blogs were monitored for 14 days.

Data analysis focused on coding and analyzing for the thematic presence of job satisfaction, servant leadership behavior and an attitude of global awareness within two recognized qualitative strategies- a categorizing strategy (coding) which disaggregated the data into substantive categories and an additional analysis of data by theoretical categories which allowed a comparison with previous leadership theory.³⁴ Substantive categories allowed “open coding” to be performed which permitted an exploration of general, overall concepts within the data while “theoretical propositions”³⁵ of Servant Leadership Theory³⁶ and a global attitude were analyzed. All interview participant and blog participant entries were coded utilizing the 54 codes listed in Table 3.

Table 3.

List of Thematic Codes by Category.

Categorical Codes	Parent Codes	Sub-Codes	Meta-Code
Intellectual Capital
	Building community
		Sense of belonging
	Commitment to growth
		Leader gives follower opportunities to grow
		Encouragement
		Empowerment
		Leader treats follower as a unique individual
	Listening
		Communication
		Humor
	Foresight
		Flexibility
Psychological Capital
	Empathy
		Understanding
	Awareness
		Leader is aware of follower's needs
Conceptualization
		Timely
Social Capital
	Healing
		Contributes to the wholeness of the follower
	Persuasion
		Respect
	Stewardship		Attributes of Servant Leadership
			Vision
			Communication
			Honesty	Credibility
			Integrity	Competence
			Trust	Stewardship
			Service	Visibility
			Modeling	Influence
			Pioneering	Listening
			Appreciation of Others Teaching
			Empowerment
			Delegation
			Encouragement

Due to the large scope of acquired data, in addition to manual coding, the qualitative cross-platform QDAS (qualitative data analysis software) system Dedoose™ was employed to code professionally transcribed interviews and blog entries. This provided the opportunity to “learn about the rich, complex and contextualized ways in which our research participants experience their lives”³⁷ which coincided with the qualitative focus of the study.

Findings

Each research question was analyzed for thematic presence of servant leadership behavior and included both interview and blog participant data. Job satisfaction task codes were used to determine the thematic presence of job satisfaction. (See Table 4, Table 5, and Table 6.).

Table 4.

Research Question 1: How do leaders describe the role they play in the job satisfaction of health information management professionals?

Themes	Theory
Building relationships with followers (appreciation of others)	Servant leadership
Committing to the growth of the follower (encouragement)	Servant leadership
Aware of the needs of the follower (puts others before themselves)	Servant leadership
Commitment to providing a positive work environment (appreciation of others)	Servant leadership
Vision for the future of the profession (vision)	Servant leadership
Aware of the needs of the profession (pioneering)	Servant leadership
Support followers in both personal and professional efforts (encouragement)	Servant leadership
Give followers praise (encouragement)	Servant leadership Job satisfaction characteristic
Provide followers with support when needed (encouragement)	Servant leadership
Put the needs of my followers before myself (puts others before themselves)	Servant leadership

Table 5.

Research Question 2: How do health information management professionals describe their experiences with the effect of the behaviors of a servant leader and job satisfaction?

Themes	Theory
Ethical behavior (ethical behavior)	Servant leadership
Leader treated them fairly and kindly (treats followers fairly) (kind)	Servant leadership
	Servant leadership
Leader show a concern for their needs before the needs of the company (put others before themselves)	Servant leadership
Leader acted as a mentor (modeling)	Servant leadership, Job satisfaction
Leader gave them the ability to grow and make decisions (empowerment) (autonomy)	characteristic

Table 6.

Research Question 3: How do health information management professionals describe how they experience job satisfaction in the United States and in Canada?

Themes	Theory
The ability to contribute to the organization (service)	Servant leadership
The ability to contribute to the success of the followers (servant to others)	Servant leadership

The use of case description³⁸ was used in the interpretation of data to find the thematic presence of servant leadership behavioral characteristics and five characteristics of job satisfaction.³⁹ Figure 2. shows a summation of thematic presence by listing the major themes found throughout the data by frequency of both interview and blog participant data.

Figure 2.

Theme Frequency.

Table 7. depicts the analysis of the 19 functional attributes of servant leadership,⁴⁰ with data disaggregated by interview and blog participants and was singled out for analysis due to its servant leadership inclusivity.⁴¹ Figure 3 shows 91 percent (10 of the 11 participant interviews) and 100 percent of blog participant entries were coded for stewardship.

Table 7.

Application of 19 Aspects of Servant Leadership to Participants

Nineteen Aspects of Servant Leadership	Interview Participants	Blog Participants
Integrity	X	X
Competence	X	X
Credibility	X	X
Delegation	X	X
Empowerment	X	X
Encouragement	X	X
Ethical Behavior	X	X
Honesty	X	X
Influence	X	X
Appreciation of Others	X	X
Leader Servant to Others	X	X
Modeling	X	X
Pioneering	X
Put Others Before Themselves	X	X
Service	X	X
Treats Followers Fairly	X	X
Trust	X	X
Visibility	X
Vision	X

Note: The stewardship parent code (inclusive of all child/meta-codes) included the 19 segments

Figure 3.

Application of Stewardship Parent Code to Participant Data.

Analysis of job satisfaction data included comparing coded results between interview and blog participant data for application of the five job characteristics of job satisfaction⁴² and the servant leadership categorical, parent and sub-codes developed from the ten-servant leadership characteristics⁴³ are found in 100 percent of all participants. (Figure 4.)

Figure 4.

Analysis of Five Job Characteristics⁴⁴ and Compared to Interview and Blog Participant Data.

Throughout the data, servant leadership themes are dominant and perfectly associated with the presence of job satisfaction in both interview and blog participants.

Discussion

Unlike quantitative research which has specific statistical calculations, “Theoretical generalization is the domain of case study as what statistical generalization is to the true experiment.”⁴⁵ This allowed the gleaning of conclusions from the application of “theoretical generalizations.”⁴⁶ Triangulation of data^47-49 was performed through the inclusion of the additional artifact of blog entries,⁵⁰ obtaining rich data through interviews and blog entries and performing respondent validation through comparison of both blog entries and participant interviews.⁵¹

This study broke new ground within two areas of previously unexplored territory of global research through the exploration of servant leadership behavior and job satisfaction within a global mindset and via both interview and blog participant data. The comparison of interview and blog data is a relatively new area of research and provides an endless opportunity of global studies to occur from anywhere around the world via virtual interviews and blog posts.

Due to the non-existence of previous research on servant leadership through a global mindset and job satisfaction via the use of participant and blog data within the health information management community a limitation to this study is an inability to compare results with previous research for enrichment⁵² or to determine replication for authenticity.⁵³ Currently, the only available comparison is research within other areas of servant leadership and job satisfaction. A systematic literature review of servant leadership and job satisfaction through both qualitative and quantitative means found a direct correlation between servant leadership behavior and increased job satisfaction^54-58 yet none of the previous results were attained from the diverse community of HIM professionals.

Conclusion

This research has shown an association of job satisfaction and servant leadership behavior within a global mindset of leadership which is applicable to the diverse community of HIM professionals. There are implications for immediate application within the global leadership and training of HIM professionals by the addition of servant leadership skills applied within a globally focused mental attitude. This research is also provides the stimulus for health information management education to include servant leadership training and application at both the associate degree and bachelor degree level.

This research provides a basis for further research:

• A quantitative study on global leadership/servant leadership and health information management professionals

• A quantitative/qualitative study on leadership behavior and job satisfaction of remote leaders of health information management professionals in the United States and globally

• A mixed-methods study on global leadership mindset and job satisfaction within health information management professionals

• A quantitative study using/comparing/obtaining data from blogs on job satisfaction in health information management professionals

“Leadership is the process of influencing others and a great organization consists of all leaders.”⁵⁹ To meet the demands of the growing and diverse community of HIM professionals, the future agenda of global leadership research must include the continuation and formalization of the application of globally transferable leadership skills which include the seven constructs of love, humility, altruism, vision, trust, empowerment, and service⁶⁰ and designates a globally aware servant leader as someone who “has an innate desire to lead by serving, serves to align own beliefs, and strives to meet the highest priorities of others.”⁶¹

Author Biography

Patricia S. DeVoy, PhD, EdS, LPN, RHIA, CPC, CPPM, (devoyps@udmercy.edu) is program director, health information management and technology, at the University of Detroit Mercy.

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