Ph.D.

Research Proposal
Doctoral Program in Business Management

Area of Study:
Leadership & Moral Reasoning

Proposed Title:
Leadership and Moral Reasoning Orientation: A Comparative Case Study of
NHS trusts with an emphasis on the Transformational Leadership
Submitted by:

Binnies P. Chacko
binniespc@gmail.com

Date of Submission: 23 / 09 / 2016

Department of Management
UNIVERSITY OF HUDDERSFIELD

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 TABLE OF CONTENTS

CHAPTERS PAGE NO.

INTRODUCTION 4

STATEMENT OF PROBLEM 5

RESEARCH QUESTIONS 6

PROJECT CONTEXT 6

PROJECT THEORETICAL FRAMEWORK 7

LITERATURE REVIEW 7

SOURCES AND METHODOLOGY 9

REFERENCES 10

TIME FRAME AND SCHEME OF COMPLETION 11

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Leadership and Moral Reasoning Orientation: A Comparative Case Study

Introduction

Leadership is described as the capacity to influence followers and subordinates towards a vision
or mission (Hope & Ronald,2005). This can be happening within an organization formally and
informally. If a leader wants to influence his subordinates, he would have a defined authority or a
position of responsibility. Leaders with high moral reasoning are admired by subordinates
(Cooper, 2004).

Transformational leadership is emerged as a significant research area in organizational

psychology. Transformational leadership is the leader's ability to motivate followers to achieve
goals beyond what was originally planned(Bass,1985). It has four features such as idealized
influence, inspirational motivation, intellectual stimulation and individualized consideration
(Bass & Avalio, 1997). This leadership is also positively related to follower's satisfaction and
behaviors (Yaun & Lee, 2011). Transformational leadership can be contrasted with two other
leaderships such as transactional leadership and laisswz-fare leadership (Bass,1998).

Positive organizational outcomes are associated with transformational leadership. So that factors
behind this leadership are very significant (Rest1990). It is noticed that both emotional
intelligence and moral reasoning are linked to transformational leadership behaviors. Emotional
intelligence means the way the social, personal, emotional skills and abilities determine
individual's function in a given environment (Bar-on 1997). Likewise, moral reasoning is one's
conceptual and analytical ability to frame socio-moral problems by using his/ her standards and
values and to judge the course of action (Rest 1997). Moral reasoning got its due attention and
importance in organizational researches due to the its contributions made to ethical leadership
which makes good judgment and moral value related issues and problems.

Scholars like Stein and Book (2000) claims that emotional intelligence is trainable. Dukerich et al
(1990) also argue that moral reasoning can be imparted in group settings through the training.
Likewise, leadership research notices that transformational leadership is trainable and able to
bring positive outcomes in the organization.

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Similarly, it is also noteworthy that the public or citizens expects that government will manage
and utilize public resources for the general wellbeing of the citizens through its officials in an
effective manner. They also expect high moral behavior from government officials (Goodling
2003). Thus moral reasoning plays a fundamental element in a democratic setting within the
public & private services. Citizens expect efficient and effective social services from government
in areas like health care, education system, property and general security of life (Cooper, 2004).
This will increase the trust and confidence of citizens on government and its officials.

Statement of the problem

The present study is an attempt to understand the moral and ethical role of National Health
Service in United Kingdom. As a public sector organization, the study intends to analyze the
way in which NHS shaped its leadership in health care system in United Kingdom. The study not
only does the analysis of NHS activities and contributions, but it also tries to understand the
officials of NHS and the way in which they influence their subordinates and to their behaviors to
achieve their vision and mission. Besides, it also looks at how these officials are ensuring and
keeping the expectations of public and to bring the trust and confidence of the citizens on NHS
social services and to its officials.

Through this study, the researcher wants to analyze the moral and transformational leadership of
NHS officials and the way ethics of care and ethics of justice are practiced by UK government in
its public health care system. Finally, the study wants to reveal how the civil society in United
Kingdom perceives the social and moral roles of NHS in UK and to unravel the ideas, notions,
perceptions and discussions of civil society towards the leadership of NHS in health care system
in UK.

For the purpose of the study, the researcher will select two NHS Trusts (give two sites and its
details here) where it has been working for a significant period in different levels. The researcher
would like to find out the moral reasoning and ethical leadership which are visible among the
NHS officials in these two NHS Trusts. Community health and health care services among the
age old people will also be noticed in these two sites. A systematic quantitative approach will be
used for data collection and for the defined objectives.

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Research Questions

How does NHS attain a moral and social role within health care system in the UK?

How does UK Government ensure the ethics of care to its citizens through NHS?

What are the main features of the NHS official's Leadership?

What are the notions of the civil society in UK regarding the NHS and what are the factors to the
conclusions?

Research Questions

To understand the historical background and moral and social role of NHS in UK

To understand the role of UK government in application of Ethics of care to the UK Citizens

To know the leadership and moral reasoning orientation of NHS officials of UK

To understand the public perception of civil society in UK on NHS

Project Context

National Health Service (NHS) in the UK was founded in 1948 but its framing started in 1942.
Arthur Greenwood, the then Cabinet Minister of Labour Party took initiatives to a
'comprehensive health and rehabilitation services'. It was based on the recommendations of
Beveridge reports. The then existing health practices were inadequate and these were mixed with
private, municipal and charity schemes. The NHS was formally established in 1948 and Aneurin
Bevan (1946-52) became the first health minister in the country. Conservative politicians and
doctors opposed NHS in its beginning. In these conditions, it is important to see the statement of
health minister Bevan on NHS in 1948 and he stated like this 'we now have the moral leadership
of the world'. Similar to this, Charles Hills, the then head of the British Medical Association gave
a radio address to the public in 1948 in which he stated that 'do you really want the state to be

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your doctor'. This was noticed by Geoffrey Rivett, the author of 'from cradle to grave- the first 60
years of NHS'. The successive governments in the nation also gave much initiatives and
attentions to the development of the NHS and even it became popular during the period of
Margaret Thatcher in 1980s. In 2014, US based Common Wealth Foundation observed that NHS
in UK is the best health care system amongst those of eleven countries it looked at.

NHS is the largest and the oldest single payer health care system in the world. The system
provides free health care service to every legal resident in UK. NHS employs 1.5 million people,
world's largest workforce and it works through its trusts.

Project Theoretical Framework

The study wants to use transformational leadership theory to understand the moral reasoning
orientation among NHS officials and their relationship as leaders and subordinates for the
purpose of the study. Study will also give attention to transactional leadership whether its features
will be visible among NHS officials and their everyday activities.

Literature Review

There are numerous studies on moral reasoning orientation and leadership behaviors. Different
aspects of leadership are discussed by various scholars.

Kohlberg (1969, 1979) initially introduced a stage theory of cognitive moral development to
explain how people think and interacting with their environment. He explains that people learn
problem solving strategies at their earlier stages and it develops in the communities in which they
work and live. He states that three stages of moral reasoning in a person's life such as pre
conventional, conventional and post conventional.

Burn (1978) explained moral reasoning and distinguished leadership behaviors like transactional
leadership and transformational leadership. Transactional leadership is viewed that it is
controlling follower's behaviors and eliminate problems by using correct transactions between
leader and follower. In contrast transformational leaders communicate a collective vision and
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inspire leaders to look beyond their personal interest for the good of the group. Burn's ideas on
transactional and transformational leadership are taken by Bass in 1985. Bass (1985) introduced
the essence of Burn's model into four transformational dimensions and three transactional
dimensions.

Barling et.al (1996) noticed that subordinate's organisational commitment is positively related to
the transformational behaviors of their supervisors. Emotional intelligence in transformational
leadership is noticed by scholars like Sosik and Megarian (1999), Barking et.al.(2000) and Bar-
on (1997). Atwater et.al (1998) speaks about the importance of the cognitive moral reasoning in
transformational leadership and the way it moderates leader's style of punishment and leader
effectiveness. Stein and Book (2000) have argued in their book that the leaders who have greater
emotional intelligence will become effective leaders. Follower' s satisfaction in transformational
leadership is described by Yaun & Lee (2000). Yukl (1998) reveals that transformational
leadership also will become unethical when they concentrate vested interest rather than collective
interest.

Proponents of transactional leadership argue that this leadership speaks about rules while it using
reward and discipline (Kuhnert & Lewis (1987); Kanungo, (2001). Kirkbride (2006) speaks that
transactional leadership is a performance based on outcomes. Fletcher& Arnold (2011) explain
that transactional leadership has some components of transformational leadership and both
represent different behavior pattern of leadership.

Yukl (1999), Judge and Piccolo (2004) described about leadership like a group of people perform
one activity or another to achieve a common purpose. Surkiewiez (2005) defines leadership is a
two-way approach which involves the leader and the subordinate. Position of authority in
leadership is mentioned by Reiman (1990).

Simola, Barking and Turner (2010) elaborates that two moral reasoning orientations visible in
leadership behaviors like an ethic and an ethic of care. They argue that an ethic of care is more
consistent than a. Ethic of justice. Taking a Canadian University as a case study, with 55
employers as in leadership positions and 391 students as their followers they argue that an ethic
of care predict transformational leadership and that an ethic of justice predict transactional
leadership. Nick Turner & Julian Barling (2002) explain that transformational leadership is

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related to high levels of moral development. They had done research in three organizations in two
countries, like one was in Canada and two were in United Kingdom with 132 leaders and 407
subordinates. They state that leaders with higher moral reasoning levels would display greater
transformational leadership than leaders with lower moral reasoning levels. Harkness, Edwards
and super (1981) addresses the relationship between moral reasoning and social roles. They did
case study among kipsigis community in Kenya and stated that community elected and
nominated leaders had shown great moral reasoning than others who were not moral leaders.
They put forward the idea that the moral reasoning of nominated leaders and non-leaders of the
community differed not because the way they approached to settle moral issue but the level of
reasoning they used in reaching the conclusion.

Using leadership principles and approaches, the present study wants to discuss the moral
reasoning orientation and leadership qualities in NHS activities in UK.

Sources and Methodology

The present study covers areas like moral reasoning, leadership orientation, emotional
intelligence, individual behavior, ethics of justice, ethics of care, public heath, civil society and
organizational psychology. The study will use both primary and secondary sources for better
understanding of the research. The researcher will do a systematic quantitative approach to
collect primary data from the selected sites of NHS hospitals. Respondents will be classified like
senior doctors, junior doctors, nursing staffs and other staffs and regular patients. This will help
to understand the relationship between leaders and their subordinates and the moral reasoning
orientation of senior authorities of NHS towards their followers and the perceptions of
subordinates staffs or followers towards their authorities who are in leadership positions. Age,
gender and work pattern also will be classified in the study. A systematic questionnaire will be
prepared for approaching and interviewing the respondents. It is supposing that regular patients
will give details about the behavior pattern and treatments of NHS authorities to them. The
attitude, approaches and perceptions of the patients also will help to know the moral reasoning
orientation of NHS authorities in the selected sites. The other significant factors of the sites will
be also noticed in the study including the systematic working of the hospital, its long periods, its

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contributions to the local society and individual behaviors behind choosing NHS hospitals than
the private hospitals. The study will use two important/ leading News Papers “The Guardian” &
“The Daily Telegraph” in UK from 1995 to 2015 to understand the public perception of civil
society towards the NHS. This will help to know how the discussions and perceptions of the civil
society directly and indirectly influenced, modified and shaped the different activities of NHS.

Besides, the study will use NHS reports, official documents, Government reports, district
Gazetteers, committee reports, autobiographies, periodicals, diaries, journals, newspaper reports,
statements and public speeches of important persons of NHS, photographs and secondary
literature on NHS, leadership and moral reasoning orientation to get a wider understanding on
leadership activities of NHS in UK.

A 3-year timetable or plan to completion

The study will be finished within three years. The researcher will do a preliminary visit to the
NHS study sites for two weeks in the initial months. This is to know the place and to get a
familiarity with the study site and to know the respondents, their time availability to make
interview or to fix appointment time with the respondents for the interview. Researcher will take
one month’s time to prepare questionnaire. The researcher will complete the pilot study/ main
field work in the initial year of the study. Personal interviews will be mainly done for the
research but sending questionnaire to the respondents by email and distributing questionnaire to
groups will help to finish the work faster. Researcher will take two months’ time to complete the
field work.

The researcher will take three weeks to one-month time to collect newspaper reports as it is
digitalised and also of a short period is selected for the study. If newspaper reports are not
available in digitalised form in press libraries, then the researcher will use digital camera to
collect the newspaper reports. It needs three to four weeks.

The researcher will start to write the first draft of the thesis in the beginning of second year and it
will be finished in the September -October months of the second academic year. The researcher
will do a final visit to the study site to collect the rest of the data which unable to collect in the

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second trip of the field work study/ pilot study. Researcher will visit libraries and research
institutions to collect, primary sources, like state official reports, committee reports of NHS and
also of secondary literature on NHS, including journals, books and articles. Researcher will
complete this task also in the second academic year of the research.

Researcher will finish the second draft of the thesis in the months between 6th and 7th of the third
year and the final draft will be completed in the last 5th months and researcher will submit his
thesis on time in the university.

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