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TABLE OF CONTENTS

CHAPTER

I. INTRODUCTION 3
STATEMENT OF THE PROBLEM 6
HYPOTHESIS 7
SIGNIFICANCE OF THE STUDY 8
SCOPE AND LIMITATIONS OF THE STUDY 9

II. REVIEW OF RELATED LITERATURE AND STUDIES

CHALLENGES AND ISSUES IN NURSING LEADERSHIP 11
LEADING MULTIGENERATIONAL NURSING STAFF 13
MULTIGENERATIONAL WORKFORCE: 17
FOUR GENERATION UNITED IN LEAN
A LEAN PROPOSAL TO BRIDGE THE GAP 18
VALUE STREAM THINKING 20
LEAN TOOLS 21
TRANSFORMATIONAL LEADERSHIP 23
TRANSACTIONAL LEADERSHIP 25
DUTIES OF A TRANSACTIONAL LEADER 26
IN AN ORGANIZATION
SYNTHESIS 26
CONCEPTUAL PARADIGM 29
DEFINITION OF TERMS 30

III. RESEARCH METHODOLOGY

RESEARCH DESIGN 32
SAMPLE AND SAMPLE TECHNIQUE 33
RESEARCH INSTRUMENT 33
DATA GATHERING PROCEDURE 36
DATA ANALYSIS 37
RESEARCH LOCALE 38
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CHAPTER 1

INTRODUCTION

(This chapter provides the background of the study, objectives, statement of the

problem, hypothesis, significance of the study and scope and limitation of the study.)

“The function of leadership is to produce more leaders, not more followers”

- Ralph Nader

As a nurse in a clinical area, how do you see yourself 10 years for now? Do you

see yourself as a specialized clinician or someone who holds a position in the hierarchy

of the organization? Everyone dreams of something bigger concerning their life. A

person may not have concrete plans for the future as of the moment but surely, as years

pass by, their experience will provide options viewing a clear picture of what they want

to be in the future. Progress depends on hard work of every individual. We have to

remember that things we want to achieve are sometimes not given to us in a silver platter

but rather, we need to work double or even triple time in order to achieve such

improvement in our lives. Too general it may seem but inside the organization of the

health care system, same thing happens. People get promoted to a higher position based

on what they have inculcated during their years of service.

I started as a junior nurse in the clinical area. I must say that it was a rough road.

Everything started with my acceptance of the career path that I have chosen. Realizing

what I want and how to get it. Sometimes, events in the hospital was a serene but

sometimes it was in chaos especially with the bulk of patients that I have to cater in a
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given amount of time. Time passed by that I begin to handle people. Teaching them and

guiding them on how to get through the nursing practice in such a way that professional

development may transpire by aiding continuous learning in the area. Now hold a

position as a unit manager of a specific unit in our institution. I must admit that greater

responsibilities are on my shoulder everyday. Even if I am on my day off, I must

entertain queries from my staff and solve problems that addressed in my position. With

my years of clinical experience, this lead to a question in my mind, “What does it really

take to be a leader in my field? Am I fostering the attributes of a future leader of the

organization? How will I gauge people in terms of their capability to lead?”. I truly

understand that sooner or later, I will give up my position and open it to another staff

worthy of becoming a manager. There will come a time that future generations will be the

one leading the institution and as my current position affects them, I want to take part in

molding them to be an effective leader equipped with all the skills necessary in a certain

position which may benefit not only their personal growth but also the innovations

present in the organization and the healthcare delivery system.

In inquiring in my personal idea, it leads to this paper as my chosen study. This

study provides an overview of generational cohorts among Baby Boomer and Generation

X leaders and millennial staff nurses management in leadership role perspective in

Ospital ng Makati. In vision to these differences in leadership skills, organizational

commitment and work attitudes and behaviors among millennial nurses in fuss with

senior nurses’ leadership framework, conflict management and work ethics.

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According to Gerrish et al, 2008, believed that: Senior nurses are developing

skills in evidence-based practice. However, the nursing culture seems to disempower

junior nurses so that they are unable to develop autonomy in implementing evidence-

based practice.

Furthermore Sarah Leavitt, 2015 said that: As there are now three — generations

of nurses working together, each with their own skills, style of communication and

expectations of nursing and the workplace which may affect how each component of the

hierarchy relates and affects one another as professionals. Nurses from the baby-boom

generation are the ones most typically in the highest leadership positions right now. They

prefer communicating and teaching in mentor-style relationships, and like to speak with

others face-to-face or over the phone. On the other hand, Generation Xers are also used to

technology — in particular, video — as a communication method, and while they’re not

as reliant on text or instant messages as millennials, they also don’t want to wait for

lengthy discussion before a decision can be made. Being the concentration of this study,

Millennials like quick communication, since they’ve grown up with email and text

messaging. They’re likely to grow frustrated when they have to wait for a response. And

they’re not really into reading lengthy communication documents, like long instructive

emails or PDFs.

Considering the difference of every age group, this study aims to provide the

relationship of each variables stated above in terms of leader formation.

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The purpose of this research study is to contribute nursing leaders to reframe

perceptions about generational differences and to view these differences in attitudes and

behaviors as potential strengths. Developing the skill to view generational differences

through a different lens will allow the leader to flex their leadership style, enhance

quality and productivity, reduce conflict, and maximize the contributions of all staff.

STATEMENT OF THE PROBLEM

This study focuses on determining the measuring differences in leadership skills,

organizational commitment and work attitudes and behaviors among millennial nurses in

fuss with senior nurses’ leadership framework, conflict management and work ethics.

Specifically, this study seeks to answer the following questions:

1. What are the profile characteristics of the respondents in terms of:

1.1 Age,

1.2 Gender and

1.3 Length of service?

2. What are the seniority complexes among senior nurses in the following aspects:

2.1 Conflict Management,

2.2 Leadership Framework and

2.3 Work Ethics?

3. What are millennial nurses insights that influences leadership skills,

organizational commitment and work attitudes/behaviors?

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4. Is there a significant difference in the respondents’ conflict management,

leadership framework and work ethics when grouped according to:

4.1 Age

4.2 Gender

4.3 Length of service?

5. Based on the result of the findings, what effective work team leadership strategies

of care can be proposed?

HYPOTHESES

H01: There is no significant difference in the respondents’ seniority complexes when

grouped according to age.

H02: There is no significant difference in the respondents’ seniority complexes when

grouped according to age.

H03: There is no significant difference in the respondents’ conflict management,

leadership framework and work ethics when grouped according to length of service.

H04: There is no significant relationship between millennial nurses insights that

influences leadership skills, organizational commitment and work attitudes/behaviors;

and seniority complexes at Ospital ng Makati.

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SIGNIFICANCE OF THE STUDY

Millennial Nurses being the focus of these study will be able to develop a unique

and appropriate leadership style as they gain more experience and climb up the hierarchy

of management. Considering their insights will also be essential in evaluating the current

nursing culture formed by the senior nurses viewing the pros and cons of the current

leadership practice. Thus, these aids millennial nurses to take a leap and be prepared to

assume a leader’s position managing not just patients but also their subordinates in

practice.

Senior Nurses being an integral part of this study may be contributory in

elucidating the current leadership framework they are using in managing the

organization. They are the ones who can observe and gauge if these nurses are lacking

certain skills that are essential in forming a leader in the future. They will also benefit in

this study through the recognition of differences in leaderships styles looking at specific

elements that can be added to their current skill rooting from the recent practice of

millennial nurses. This will provide an innovation for improvement of their leadership

trait that may help in the progress of the department or the organization.

Nurse Managers The study may serve as a reference for them to be successful in

leading and managing their colleagues in the organization. The result of the study can be

used as a basis for work team leadership strategies.

Nursing Administrators being in the top of the hierarchy are usually focused on

maintaining the current status quo of the nursing department as to its relation to other

departments whether administrative or clinical. The study may aid in the development of
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a progressing nursing culture and stabilize an environment appropriate in formulating

future nursing leaders. They are the ones who have the capability to implement leadership

strategies to help empower and senior and millennial nurses as they pass the position to

them in the near future.

Future Researchers

The study may aid as reference or baseline for the future researchers who will be

interested in conducting similar studies. Recommendation from this study can also help

them conduct new studies to further enhanced the information

SCOPE AND LIMITATION

This study includes baby boomers and generation X as respondents which has a

certain style formed during their years of practice. They are the ones of the top/ middle of

the management hierarchy nowadays handling a position as a manager or a supervisor of

the nursing department. This study includes these age group as respondents as they share

their current leadership framework, conflict management and work ethics in order for

them to maintain a harmonious organizational process. These enables the provision of

their leadership practice as to the current practice of millennial nurses. In addition, this

study also includes millennial nurses’ description of the leadership framework, conflict

management and work ethics of senior nurses through a survey tool. This study focuses

on leadership characteristics concerning different age groups, gender and the length of

service of these nurses. This study also includes nurses with more than 5 years of
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experience in the clinical area, making them experts and assumes a leadership role in the

workplace a bigger role in the near future.

On the other hand, this study is limited to senior nurses’ view of the leadership

skills, organizational commitment and work attitude of millennial nurses and the insights

of millennial nurses on leadership framework, conflict management and work ethics of

senior nurses. A reciprocating relationship will be viewed using this study in order to

associated the elements stated above. This study is also limited to leadership

characteristics alone not considering other factors associated with their current leadership

ability. Also, limitations are present in the age groups as senior nurses may be baby

boomers or generation X member while millennial nurses are those with no less than 5

years of service in a certain tertiary hospital only, Ospital ng Makati. Other issues and

other factors that may be considered as a separate variable are not included in the study.
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CHAPTER II

REVIEW OF RELATED LITERATURES AND STUDIES

(This chapter includes literature and studies that will be useful and instrumental to

the completion of the study, It will discuss the theoretical bases of the study and research

works written that will answer the major and minor problems about the topic, the

conceptual framework that will guide the flow and analysis of the paper, and the various

key words and phrases that will be used within their appropriate operational definition.)

Challenges and Issues in Nursing Leadership

In an article written by Zydziunaite (2012), she cited that in today’s ever-changing

health care environment, nurses require leadership, which provides direction for a new

generation of nurses. The past, present and future leadership setting, role of authority,

power and influence in leadership, components of the arch of leadership and solutions to

effective leadership in a future dimension is all domains that motivate future nurse

leaders. Then gaining knowledge to become an effective nurse leader is one way to

ensure quality health care for the future.

Leadership can be defined as a multifaceted process of identifying a goal or target,

motivating other people to act, and providing support and motivation to achieve mutually

negotiated goals. Often the definitions of the words leader and manager are not rare

confused. Traditional managers have assigned roles and titles within an organization, as

they carry out specific functions, duties and responsibilities. Leaders do not necessarily

have any delegated authority. They function within a variety of formal and informal
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roles. An individual can be a great leader but not a manager. Conversely, an individual

can be a manager but not possess many leadership skills. Thus the nursing leadership

does not rest merely with administrators and high-level managers, but also can be

developed and implemented at the bedside.

Nurses are likely to engage in a range of leadership activities in their daily routine.

Some will naturally adopt an effective leadership style, while others may find the concept

of leadership or seeing themselves as leaders difficult to understand. Effective leadership

is critical in delivering high-quality care, ensuring patient safety and facilitating positive

staff development. Within the nursing and care practices, anyone who is looked to as an

authority (e.g., a nurse taking care of a patient) or who is responsible for giving assistance

to others is considered a leader and the nurses leaders, according to Bondas (2006) and

Roskoski (2012), are driving forces and vital to good patient care. This argument is

related to Frankel affirmation that dynamic clinical leaders and supportive clinical

environments are essential in the development and achievement of best practice models.

What means that nurses leaders act within various organizational environments that could

motivate or not, the nurse leaders to seek for the best health care as well as nursing

quality for their patients, society and nursing profession.

According to Wisniewski (2012), characterizes the nurse leaders as creative and

innovative; utilizing their personal influence to empower others and challenging the

status quo; they are life-long learners, empathetic, advocates who speak on behalf of their

patients, decisive, extraordinary, resilient, supportive, heroic, and intuitive and purpose

driven. Then these arguments show the importance of cultivating new nursing. Leaders
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are imperative for a healthful society, to the best evidence-based nursing practice as well

as to the need to train the nurses for leadership. In this context Valentine (2012) notes

that we need nursing leadership to exert that influence and by nurturing both leadership

as well as clinical skills, we can. Also she raises the issue that the nursing profession

trains new nurses on operating the latest technology and complex medical equipment. In

contrast, once at the bedside they rarely get the opportunity to apply even basic

leadership principles. Nursing as a profession does a disservice to new nurses by not

developing their leadership capabilities. Nursing has a responsibility to encourage and

support new members of the profession, as they become competent clinicians. Nursing

must also make them competent leaders.

Nursing practice needs evidences that are proved by research outcomes. Integration of

research evidence into clinical nursing practice is essential for the delivery of high-

quality nursing care. Leadership behaviors of nurses, especially, managers and

administrators have been identified as important to support research use and evidence-

based practice. Yet minimal evidence exists indicating what constitutes effective nursing

leadership for this purpose or what kinds of interventions help leaders to successfully

influence research-based care.

Leading a Multi-Generational Nursing Staff

Nurse Managers are leading teams made up of four generations: traditionalists

(veterans), baby boomers, Generation X and Generation Y (millennials). This range of

ages presents a unique opportunity for staff leaders — the ability to harness a variety of
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different skill sets, outlooks and ideas. Along with this opportunity, managers must

prepare for obstacles that arise from leading a multi-generational nursing staff. The

differences between the three generations — excluding traditionalists — in nurses’

characteristics, job satisfaction, and quality of work life and psychological empowerment.

Baby boomers were found to have more experience and higher levels of psychological

empowerment and job satisfaction compared to Generation X and millennials. However,

there were no differences found in the three generations’ work-life quality. The results

revealed nurses’ sociological value systems had a major impact on their perceptions of

their work environment. (University of Bradley, 2016).

According to Sherman (2011), it can be challenging for nurse leaders to guide

their teams to get past their conflicts and communication issues to work together in

harmony. If you are an emerging leader, it is likely that you are either from Generation

X or Generation Y. You may find yourself supervising nurses from a generational group

that is different from your own. As a nurse leader, you will play a key role in setting the

tone and culture of the units or departments that you lead. The journey of building a

culture of inclusion and respect begins with insight into your own generational beliefs

and biases. The research that has been done with generational groups indicates that

generational cohorts share birth years and a collective life experience that helps to shape

their values, work ethics, attitudes toward authority and professional aspiration.

The veteran (born 1925-1945) generational cohort has already retired but some

continue to work in both staff and leadership positions. The Veterans grew up in difficult

times with life experiences that included World War II and the Great Depression. The
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economic and political uncertainty that they experienced has led them to be hard

working, financially conservative, and cautious. Veterans value the lessons of history.

When facing new challenges, they look to the past for insight into what has worked and

what hasn’t. Organizational loyalty is important to this generation, and they feel seniority

is important to advance in one’s career. They tend to be respectful of authority,

supportive of hierarchy, and disciplined in their work habits.

Baby Boomers (born 1946-1964) grew up in a healthy post-war economy.

Nuclear families were the norm. They were encouraged to value their individualism and

express themselves creatively. Often described as the most egocentric generation, they

have spent their lives rewriting the rules. The Baby Boomer generation is the largest

cohort in the nursing workforce and currently occupies many nursing leadership

positions. Baby Boomers are known for their strong work ethic, and work has been

a defining part of both their self worth and their evaluation of others

The Generation X (born 1965-1980) cohort is significantly smaller than the Baby

Boomers. During the 1990s, the profession of nursing had significant problems attracting

Generation X members who saw nursing as not offering the career growth and

entrepreneurial opportunities available in other jobs. However, many Generation Xers

have now entered nursing as a second career and significant numbers are in leadership

positions.
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The Millennials (born 1981-2000) are the second largest generational cohort in

the general population and over the next ten years will be the largest cohort in the nursing

workforce. They were raised in a time where violence, terrorism, and drugs became

realities of life. Raised by parents who nurtured and structured their lives, they are drawn

to their families for safety and security. They are a global generation and accept

multiculturalism as a way of life. Generation Y are the first true digital

natives. Technology and the instant communication made possible by cellular phones

have always been part of their lives. This generation is often compared to the Veterans in

their values. A higher level of interest in nursing among this generation has been

noted and applications to nursing programs significantly increased as they entered

college.

According to Moore et al., (2016), each group has unique characteristics that add

complexity to the workforce and this can add challenges to providing optimal patient

care. Multigenerational workforces can provide rich environments that support an

atmosphere of diversity and growth (Mercier, 2012). Respect and understanding can be

outcomes of organizations that recognize generational differences. The purpose of team-

building within multigenerational nursing teams is to promote patient safety and other

positive organizational outcomes through improved understanding, communication,

inclusion, trust, and respect. Both nursing administrators and individual team members

have a responsibility to work toward these goals, however challenging. In today’s

dynamic and fluid healthcare environment, it is prudent to attract and retain staff by
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appealing to and providing a supportive environment for nurses of all generations.

Education regarding generational differences, similarities, and transparent

communication along with successful team-building can help to make this happen.

(Stanley, 2010)

Multi-Generational Workforce: Four Generations United in Lean

According to Lewis & Wescott (2017), the challenge of managing a multi-generational

workforce is prominent in the literature as four generations try to create a cohesive

workspace. This environment offers challenges and opportunities for organizational

leaders, as these generations differ in perspectives, attitudes, values, characteristics and

behaviors. Companies that do not address the generational differences risk being less

efficient, with higher turnover rates; two critical elements businesses must focus on to

remain competitive in their markets. Lean improvement initiatives seek to drive

efficiencies in processes by empowering employees to engage, create a collaborative,

problem-solving environment, and a culture of continuous improvement. Lean may be

one solution for gathering the generations. Through an evaluation of literature, a table of

characteristics and values for each generation is created. Additionally, a compilation of

survey results displays generational preferences and priorities related to a variety of job

satisfaction factors. The results are aligned to lean tools, concepts, and principles that can

address the characteristics and working preferences of the generations. This paper

proposes that the principles, concepts, and tools of lean process improvement may be a

solution to bridge the gap between the generations, improve the efficiency of the

organization, and create a cohesive culture.

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A generation is generally defined as a group of individuals born in a defined

twenty year period or within a period that offered a shared social experience (Lyons &

Kuron, 2014; Weingarten, 2009). This much-studied topic dates back as early as 1940

with research done by Kingsley Davis who found factional conflict occurred when

different generations worked in the same organization (Gusfield, 1957). While the theory

is now fully accepted in academia, the media, and the average American, there are also

opponents of the theory. Most of the criticisms of the theory include the difficulty in

controlling variables in life experiences, familial and religious influences, and the

evolution of our personalities in the normal aging and experiential growth processes.

Lean is widely recognized as a process improvement methodology that allows a

company to cut costs and improve quality by actively engaging all members of the

organization (Dennis, 2006; Haynes, 2011). The application of lean principles could be a

solution to engage employees to create a cohesive, content, and efficient multi-

generational workforce.

A Lean Proposal to Bridge the Gap

According to Teich, 2013), The objective of lean is to drive the organization’s

business practices to the most efficient are designed to make problems visible (Dennis,

2006; Mann, 2015; Womack, 2011). The successes of Lean initiatives are well

documented in manufacturing businesses such as Toyota, Boeing, and Dell (American

Society for Quality (ASQ), 2015; Chen & Cox, 2012; Dennis, 2006; Mann, 2015;

Womack, 2011). The application of lean can extend far beyond manufacturing. The
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benefits can be achieved in any industry, with strong acceptance in fast food, health care,

and insurance, and applies in the front office, administrative, distribution, and

manufacturing processes.

Lean has an additional benefit which is to change the culture of an organization –

a necessity to successfully implement lean initiatives (Mann, 2015). Through the use of

these concepts and tools, generational conflicts may be resolved by creating clear roles,

responsibilities, tasks, objectives, goals, and accountability in organizational processes.

Lean concepts and tools provide just such a framework for systematically approaching

problems and generating improvements, providing the framework for employees to

leverage their different vantage points to improve processes (Mann, 2015; Womack,

2011).

Lean Concepts

The concept of Socratic leadership is not new, as Socrates introduced it over 2500

years ago as a process to help people systematically think through the stages of idea

development to formulate solutions (Metcalf, 2015). The Socratic leadership method is

the process of asking a series of probing questions and offering answers that may be

contrary to the employee’s current understanding of a situation (Dennet, 2014; Schein,

2013; Tucker, 2007). By following this process, employees learn to think differently and

analyze the problems they encounter with a new approach.

Experiential learning is a key concept embraced by lean practitioners (Kumar,

2012; Womack, 2011). While Kumar (2012) eloquently explained experiential learning
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as “knowing through empathy and resonance” (p. 53), it can be simply stated as a culture

that allows employees first-hand experience to evaluate problems, recommend

improvements, and implement their own solutions. Through this cycle of

experimentation, the learning is “richer, deeper, more true to life, and more useful”

(Kumar, 2012, p. 53). This problem-solving approach resonates with people because they

are able to learn about the process, apply their proposed solutions, and reflect on the

results generated (Kumar, 2012) which also follows the individual Socratic

Action/Reflection loop (Lennartsson, Ekinge, Sundin & Soderman, 2004).

Value Stream Thinking

Organizations that embrace value stream thinking are those that break down

fences or silos around departmental functions and instead see processes from an end to

end perspective (Keyte & Locher, 2004; Mann, 2015). Value streams are a series of

connected process and activities necessary to deliver results (products, service, and

information) to the customer (Brown, 2009; Chen & Cox, 2012; Mann, 2015). The value

stream perspective streamlines confusing, chaotic processes, providing visibility and

accountability to bottlenecks (Brown, 2009). It is essential to switch the culture from a

functional perspective to a process perspective to improve efficiency, morale, and team

cohesion (Dennis, 2006; Kymal, 2004; Mann, 2015).

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Lean Tools

There are a wide variety of lean tools, providing a systematic and repeatable way

to approach problem-solving, understand processes, identify improvements, and measure

process stability (Mann, 2015; Michael, Naik, & McVicker, 2013

Standard work is the documented best way we know how to perform a task. It

should include the specific sequence of tasks, the time to perform the task, and quantities

that must be performed to meet the customer demand (Mann, 2015). When effective

standard work exists, any employee can follow the directions to generate a consistent

output. It allows a standard process for all employees to follow. As employees improve

their process, they should update their standard work. This tool stabilizes processes, to

drive efficiency and profitability as well as improve morale. Standard work clearly

defines roles, responsibilities, and establishes accountability (Mann, 2015).

SIPOC is an acronym for Suppliers, Inputs, Process, Outputs, and Customer.

When created in a group setting, this diagram helps the team visualize the scope and

objectives of each process within their functional area (ASQ, 2015). By defining each of

these elements of a process, the gaps between what the customer expects of the process

and what it is actually delivering. It allows the team to begin to see their processes from a

higher perspective and how or why the process is failing to meet the expected outcomes.

A key element of improving the work and the work environment is to switch from

being functionally focused to becoming process focused. A process map demonstrates the

individual, sequential steps required to perform a task. It documents the activities

required by the employee, the connections to other processes or departments, and the
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material or information flow through the entire process (Kymal, 2004). Sometimes these

maps are referred to as swim lanes or flow chart maps although each is designed for a

specific application (Tapping, Fertuck, Baban, & Dunne, 2010).

The VSM allows the team to see how a process is performing by documenting all

details related the process. This is a more in-depth visualization than a process map as it

includes very specific measures of work in process, cycle times, takt times, volumes,

touch times, manual decisions, and rework (Keyte & Locher, 2004; Tapping et al., 2010).

By measuring all of these elements of the process, the team can clearly see where non-

value added activity is occurring and prioritize their improvement efforts accordingly.

KPIs may be perceived simply as metrics, but in fact, they are a deliberately

selected group of metrics that measure the processes that directly impact strategic

initiatives of an organization (Becher, 2006). KPIs are a necessity in lean transformations

to ensure improvements are generating the expected results and steering the organization

in the desired direction (Becher, 2006; Tapping et al., 2010). They help align employee

efforts, define the standards for employee activities, and align accountability. These KPIs

should be reviewed and discussed with employees working on the process using the

Socratic leadership method during gemba walks.

The gemba walk or go see activity allows leaders and team members to directly

observe the work as it is performed (Dennis, 2006; Womack, 2011). This activity

provides insight into inefficiencies that cause the employee to work around processes in

order to accomplish their tasks. For team members, gemba walks provide insight into

why connecting processes don’t support their efforts, prompting the team to understand
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that the process was causing the problems, not the people (Dennis, 2006; Womack,

2011). This can be an enlightening activity to help employees find common ground and

help one another improve processes through teamwork and collaboration.

For leaders, it is an opportunity to see how the team is working together to execute their

tasks, following standard work, and meeting the workload processing plans in place. It

provides an opportunity for one on one discussion, allowing team members to express

items that are going well and those that are hindering their process success (Womack,

2011). Socratic leadership is an essential element of interaction during the gemba walk.

Effective Leadership styles

According to Voon et al. (2011), Leadership is a process influence between

leaders and subordinates where a leader attempts to influence the behavior of

subordinates to achieve the organizational goals. Organizational success in achieving its

goals and objectives depends on the leaders of the organization and their leadership

styles. By adopting the appropriate leadership styles, leaders can affect employee job

satisfaction, commitment and productivity. Two types of leadership styles, namely,

transactional and transformational were found to have direct relationships with

employees’ job satisfaction.

Transformational Leadership

Simola et al. (2012), define transformational leadership as a type of leadership in

which interactions among interested parties are organized “around a collective purpose”

in such a way that “transform, motivate, and enhance the actions and ethical aspirations
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of followers.” Transformational leadership is a leadership style that seeks positive

transformations “in those who follow” and that achieves desired changes through the

“strategy and structure” of the organization (Geib and Swenson, 2013).

Transformational leadership can be contrasted with transactional leadership. The

latter implies leadership based on an exchange process wherein autonomous agents may

benefit, which in turn implies reciprocity (Simola et al., 2012). Bass (1990) indicates that

transactional leadership can be characterized by several elements not necessarily

mutually excluding. The first dimension is that of contingent rewards or the recognition

of achievement by rewarding efforts and good performance. The second is active

management by exception which is directed at managing the process. Leaders monitor

the lack of compliance with established rules and standards, and when required undertake

corrective measures. Transactional leadership can also focus on passive management by

exception. In the latter, leaders are meant to intervene only in cases in which set

objectives are not achieved. The last characteristic of transactional leadership is laissez-

faire in which leaders avoid making decision and those involved in the process relinquish

all responsibilities.

Wang and Howell (2010), argue that transformational leadership can be focused

on the individual and group levels. In the first instance, the aim is to empower individuals

in order to “develop their full potential, enhance their abilities and skills, and improve

their self-efficacy and self-esteem.” The influence of the leaders is strengthened by their

interest in the followers as individuals. Transformational leaders strive to understand

employees’ abilities, skills, and needs, and offer them coaching and mentoring to
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overcome any weaknesses. At the group level, transformational leadership develops

common values and beliefs, and inspires unity in order to reach group goals. In this

situation, leaders behave equally toward all members of the organization, and the latter

have a common perception about the leader’s behavior.

Transformational leaders are able to articulate the organization’s common

purpose in a way that emphasizes the social dimension of the process: the impact of one

individual’s actions on the greater group beyond the firm. The vision thus clearly

accentuates the meaningfulness of the consequences of each action for the organization

and its stakeholders (Grant, 2010). In so doing, the transformational leader encourages

others to adopt the transformation process as their-own and thus allows for the attainment

of the targeted transformation. To put it sharply, the success of the transformational

leaders is defined by their ability to offer others something that goes beyond self-interest:

they provide other with “an inspiring mission and vision and give them an identity” (Geib

and Swenson, 2013).

Transactional Leadership

According to Tiwari and Sharma (2017), Transactional leadership is a technical

leadership and somewhere hard headed than transformational leadership because it is

straight forward in its vision and occupies technical approach to set and get goals. “A

transactional leader focuses on the role of supervisor, organization and group of

performance. They are concerned about status quo and day to day progress towards

goals”.
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DUTIES OF A TRANSACTIONAL LEADER IN AN ORGANIZATION

This can be fulfilled by leading an example for motivation. When first example is

put forth employees, they willingly follow them. A transaction leader set goals, make

strategy and research at every level competivity; Positive atmosphere of an organization

cultivate and maintain a workforce to prove quality output and involves employees with

sense of responsibilities. A transactional leadership steps forward according to said goals;

managerial leadership unifies all his employees by positive attitude. His maximum efforts

have been denoted to use all unique skills and talents of subordinates; total quality

manager always garner customer focus attitude to meet customers’ requirements; A

Transactional leader demonstrates confidence, take risks and evidence based decisions to

make his personal image so that could exemplify his self towards employees.

SYNTHESIS

Leadership can be defined as a multi-layered process of identifying a goal,

motivating other people to act, and providing support and motivation to achieve mutually

negotiated goals. Leading a multigenerational workforce is not easy. It is vital for leaders

to evaluate their current culture in order to ensure they meet the needs of their multi-

generational staff. The generational differences in work values, desire for work-life

balance, motivators, and use of technology which we have identified create opportunities

for organizations to design various strategies and adapt their management styles to

increase workplace satisfaction. These polices can encompass numerous areas including
 27

communication mechanisms, training and learning opportunities, rewards, and other

benefits.

Generational differences on workplace should not avert managers from seeing

how they can also influence those different outlooks to bring out the best in their

employees and teams. For instance, Matures are detail-oriented, loyal, and bring with

them the knowledge and practical experience about what has worked or not worked in the

past. These characteristics would be beneficial in executing strategic projects. The Baby

Boomers enjoy working on teams, are good at building relationships and also bring

knowledge and experience. Placing them on teams with younger employees would be

advantageous, as they can both lead and teach. Generation X is independent, adaptable,

and a bit skeptical. Organizations can utilize these employees when change is necessary,

as they can play devil's advocate and challenge the status quo. Lastly, Millennials are

optimistic, tenacious, and team-oriented. Organizations have an opportunity to groom

these driven employees to be high-performing team members by assigning them mentors

and giving them ample opportunities to learn and grow. If companies are able to adapt

their workplaces to accommodate the generations' various values and needs, while also

harnessing these assets and directing them toward driving results, they are in a position to

establish a competitive advantage and retain quality employees.

Leadership styles like transactional or autocratic, transformational leadership

addresses an individual needs, while the transactional leadership addresses the

organizational process and the functioning is more often considered to be monopoly in

nature. The decisions made are concerned only with the leader, success and failure occurs
 28

in an equal probability. While transformational leadership indulges effective team work,

the leader motivates his follower and provides constructive feedback. The significant

feature is that, feedback is expected from the follower too thus creating a two way

communication. In the current world, transformational leadership is highly recognized

and practiced by executives in modern organization. The current business scenario is

influenced by insecurity, global commotion and organizational volatility, for which

transformational leadership would be a better solution to deal these factors efficiently. As

a conclusion, this study entails to view the perspective of millennial nurses based from

the current culture present in the organization. With the aforementioned data above, the

researchers will tend to view the leadership framework, conflict management and work

ethics that is evident in their present practice with an end product to come up with a

program that will aid in the formation of new leaders that will holding their respective

positions in the future.

 29

CONCEPTUAL PARADIGM

SENIORITY COMPLEXES
Conflict Management

NURSE Leadership Framework

Work Ethics WORK TEAM

Age
LEADERSHIP
Gender STRATEGIES
Length of service

MILLENNIAL NURSE
INSIGHTS

INPUT PROCESS OUTPUT

Figure 1
Seniority Complexes among Staff Nurses in a Tertiary Government Hospital: A
Millennial Perspective Development of Work Team Leadership
Strategies

The First box represents the respondents Age, gender and length of service .These

demographic data’s used by the researcher will help to delimit respondent’s

characteristics representing the input of this study. The first solid line arrowed to the

process boxes: the first box of the process is the seniority complexes among the senior

nurse respondents which include the following: Conflict management, Leadership

Framework and Work Ethics. On this process, the researcher will use the weighted mean

to gather the preferred styles of conflict resolutions, the demonstrating personal qualities
 30

among leadership framework and practices, conduct, and disagreements among work

ethics in form of questioning. The second box in the process is the Millennial Nurses

insights questionnaire that senior nurses will give their own perception, views and

opinions in focus group discussions (FGD). The interrelated line for the process box to

weight the views of both senior and millennial nurses. The second solid line to the output

is the Work Team Leadership Strategies.

This study can be represented using this conceptual paradigm which is divided

into three. With all of these variables, the output of this study is the formulation of work

team leadership strategies to enhance the development of future leaders in the workplace.

DEFINITION OF TERMS

Baby Boomers are an age group consists of persons born in the 1940’s until the 1950’s.

They also assume a position in the nursing organization even higher than Generation X

individuals and granted with a management role due to their years of experience.

Generation X is an age group consists of persons born in the 1960’s until the 1970’s.

They are also termed as senior nurses who assume a position in the nursing organization.

Millennials is an age group consists of persons born in the 1980’s up until the present

time.
 31

Seniority Complex is a term associated with the current leadership and management

practice of a person assuming a leadership role or position. It may either be a positive or

negative characteristic which is rooted from a culture and the learnings associated with it.

Strategies are objective methods/ technique in performing a specific function to achieve

a goal or a purpose.

Work Team Leadership is a specific type of leadership characterized as ability to

handle people and provide coordination from person to another in the achievement of a

common goal or a specific function

 32

CHAPTER III

RESEARCH METHODOLOGY

(This chapter provides the research design, research locale, sample and sampling

techniques, instrumentation, data gathering procedure and ethical consideration.)

RESEARCH DESIGN

In inquiring for seniority complexes in staff nurses, a mixed method will be

utilized. Meaning, both qualitative and quantitative process will be performed to answer

the problems stated in the previous chapter. A quantitative descriptive correlational will

be used to inquire seniority complexes in a senior nurses’ perspective and practice. This

process is performed to dig deeper to an event or experience as senior nurses compare

their established leadership framework, way of conflict management and work ethics

over the millennial nurses leadership skills, organizational commitment and work

attitude. The conflict management tool by University of Arizona and the Leadership

Assessment Framework tool of NHS Leadership Academy (2012) have been adapted.

Another concept that will be used in this study is qualitative phenomenological.

This will be facilitated by getting a sample of millennial nurses and answering The 2015

Deloitte Millennial Survey to gauge senior nurse’s insights among millennial nurses.

Variables such as age, gender and length of experience will be related to their perceived

seniority complex. This will be facilitated in a form of focus group discussion with a

semi-structured questionnaire as a tool.

 33

With this mixed method, this study aims to produce a work team leadership strategy to

mold millennial nurses based from the established leadership qualities of the senior

nurses.

SAMPLE AND SAMPLE TECHNIQUE

The sample of the study will compose of one hundred fifty (100) millennial

nurses from different areas and fifty (10) senior nurses with at least 5 years of experience.

The Sloven’s formula (N/1+Ne^2) will be used in both age groups to get the total sample

from the population from this study. Aside from that, Stratified Random Sampling will be

utilized to get respondents in different clinical areas concerning the millennial population.

On the other hand, a Random

Sampling technique will be used in selecting respondents for the senior nurses’ age group

which consists of nurses in the top and middle management with years of experience.

RESEARCH INSTRUMENT

To inquire on the millennials perspective, the researcher will adopt the 2015

Deloitte Millennial Survey. The twelve (12) items in open- ended questionnaires for

focus group discussion in answering this tool meant for the senior nurses. The conflict

management tool by University of Arizona and the Leadership Assessment Framework

tool of NHS Leadership Academy (2012) have 25 items questionnaire for conflict
 34

management, 48 items for leadership framework assessment; and 12 items for work

ethics for millennial nurses.

Demographics such as age, gender and length of service are to be answered by the

respondents because data will be used as variables.

Validity and reliability test is not necessary since the researcher will ask the

permission of the developer of the tool.

Other instruments such as pen and paper including an audio recorder will be used

to store what transpired during the interview for transcription, translation and for future

reference

Such statistical formulas will be used:

 Frequency percentage – to present the percentage of data that exists for each data

point including the frequency that such answers were picked by the respondents.

fi = f/n x 100

__is__ = __ %__ or part__ = %__

of 100 whole 100

 Weighted mean – to present the average in the series of data considering data that

count more than other data sets.The Weighted mean for given set of non negative

data {x1, x2, x3, ...xn} with non negative weights {w1, w2, w3, ...wn} can be derived

from the formula

 35

∑𝑓1 𝑥1
𝑥̅ =
∑𝑓1

Where, x¯ = weighted mean.

xi = x1,x2,x3...... = Items given.

and fi = f1,f2,f3,...... = Frequencies corresponding to the given items

 Correlation ANOVA t-test – to determine the correlation of one variable to the

other. This study aims to correlate the leadership framework, conflict

management and work ethics over the age group of the respondents. This can be

computed using this formula:

ANOVA: 1. State the Hypotheses

State the Hypotheses

– Null Hypothesis: μcontrol= μtrt 1= μtrt 2

– Alternative Hypothesis: at least two of the means (μ control, μ trt 1, μtrt 2) are not equal

ANOVA will identify if at least two of the means are significantly different

The null hypothesis of equal means is rejected by the critical value method (5.73 > 3.68)

or the p-value method (0.014 < 0.05). We can conclude that AT LEAST two of the means

are significantly different.

∑y1 2 ∑(y, −y)2

ỹ = s =
N N−1
 36

DATA GATHERING PROCEDURE

Data gathering will be facilitated using a two-step process:

Step 1. The initial step in data gathering procedure is by letting the respondents

sign a consent in their participation in the study. The consent explains the whole purpose

and the extent of participation of the respondents chosen. Ethical considerations as to the

Research Development and Innovation (RDI) and Ospital ng Makati Research Et

(OMREB)

Step 2. The data gathering process will start by determining the seniority complex

of senior nurses on their own leadership framework, conflict management and work

ethics. This will be done by gathering the senior nurses in a focus group discussion using

a semi-structured interview with the use of audio recording and note taking that may last

for a few sessions until saturation point is attained. Transcription and translation will also

be facilitated to obtain an organize collation of what transpired during the interview. This

will facilitate the qualitative segment of the study.

Step 3. The questionnaire distribution to selected millennial respondents. Using

stratified random sampling as the sampling technique, respondents will be chosen and be

given questionnaires to answer. The questionnaire is intended to measure the millennials

perspective in terms of their leadership skill, organizational commitment and work

attitude.

Step 4. As the questionnaires are retrieved, the researchers will compute for the

percentage frequency, weighted mean and ANOVA using SPSS that will serve as a

numerical basis and evidence of this study. Special concentration will focus on the
 37

relation of age and length of service to the variables associated with millennials. This will

form the quantitative process of the study.

DATA ANALYSIS

Once data has been collected and computed, analysis will take place. Qualitative

analysis will be performed by looking for common themes based on the statements of the

senior respondents. Themes are procured using the statement coding process as to finding

the deeper meaning of the statements. The common statements will be grouped according

to how similar codes are formed. This coding will provide common themes that lead to a

specific theme that will be the concentration and result of the qualitative process. Thus,

this description of senior nurses will define their leadership framework, conflict

management and work ethics termed as seniority complex. On the other hand, qualitative

analysis will be done by descriptive correlation coefficient specifically the relation of age

and length of service to the subsets results providing its significance or difference with

each other. This will gauge the millennial nurses’ leadership style, organizational

commitment and work attitude. Both qualitative and quantitative analysis will lead to the

insight of millennial nurses on seniority complex in a tertiary government hospital setting

that will be the basis for the proposal of a work team leadership strategies.
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Research Locale

Ospital ng Makati is a government hospital aimed at improving health and

medical services to indigent communities in Barangay Pembo in Fort Bonifacio, Makati.

It is among Makati hospitals that perform simple medical and surgical procedures, like

blood-letting programs, lip surgery among the kids, and rescue and quick response during

emergencies and disasters. It also does medical, health, and maternity consultations,

regular checkups, and simple health diagnosis. The hospital also accepts maternity cases.

With its present needs and challenges, the local government of Makati is currently

looking for options to address the need to improve this hospital facility.

The vision is to make Ospital ng Makati into a state of the art hospital providing

ultimate health care service. With its mission to ascertain the evolution of Ospital ng

Makati into a world class hospital through delivery of an efficient, quality and affordable

health care served in a humane and compassionate manner that ensures client satisfaction.

Ospital ng Makati (OsMak), the premier tertiary hospital has been granted the

ISO 9001:2008 Certification for its Quality Management System by SGS Philippines, the

world’s leading inspection, verification, testing and certification company.

SGS audited and certified the following processes at OsMak: Admitting of

patients to ER up to discharge of in-patients; Medical diagnostic (Radiology and

Laboratory) services for both in-patients and out-patients; Health records and

documentation management and Admitting; Finance including Philhealth and MHP

 39

administration; Support offices such as HRMO, Building and Medical equipment

maintenance (BEMSS), Information Technology and Central Supplies Warehouse.

The standards met by the hospital that earned the ISO nod included, among

others, disposition of patients at the Emergency Room made within six hours; admission

process completed within 20 minutes; period of transaction from billing to discharge

within one day; laboratory results for in-patients and ER patients obtained within two to

three hours; and radiology results within two days.

OsMak provides free outpatient consultations and subsidized hospitalization

benefits to Makati residents, particularly beneficiaries of the Yellow Card (Makati Health

Plus) program and senior citizens. It offers a wide range of quality medical services,

which include Obstetrics and Gynecology, Pediatrics, Surgery, Ophthalmology, Internal

Medicine, Otorhynolaryngology, Dermatology, Radiology and Laboratory.

In a move to decongest the Ospital ng Makati and bring tertiary health services

closer to the people of the first district, the city government has prioritized the

construction of a second hospital at the site of the Ospital ng Makati Acute Care Center in

Bel-Air. The new hospital will have six major operating rooms and two minor operating

rooms; an ER with a Trauma Center; 32 critical care beds in the ICU and NICU; an MRI

suite and an Ultrasound suite, and top-of-the- line laboratory facilities.