ORGANISATIONAL CULTURE LEADERSHIP Asmri_Thesis.pdf · organisational culture, leadership behaviour…

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  • ORGANISATIONAL CULTURE, LEADERSHIP BEHAVIOUR AND JOB

    SATISFACTION AMONG PRIMARY HEALTH CARE PROFESSIONALS IN SAUDI ARABIA:

    A MIXED-METHODS STUDY

    Mushabab Saeed Hassan Al Asmri Dip HSc (Abha College of Health Sciences)

    BHSc (Curtin University) MAP C&PHC (Griffith University)

    Submitted in fulfilment of the requirements for the degree of

    Doctor of Philosophy

    School of Public Health and Social Work, Faculty of Health

    and Institute of Health and Biomedical Innovation

    Queensland University of Technology

    November 2014

  • I

  • II

    Keywords

    Saudi Arabia

    Health Care System

    Primary Health Care

    Job Satisfaction

    Health Care Professional

    Leadership Behaviour

    Organisational Culture

    Mixed Method

    Semi-structured Interviews

    Focus Groups

  • III

    Abstract

    This thesis explored the relationship between organisational culture (Innovative,

    Bureaucratic, and Supportive) and leadership behaviour (Consideration and Initiating

    Structure), and their effect on job satisfaction for front line primary health care (PHC)

    professionals in the Asir region of Saudi Arabia. The purpose of this study was to

    improve individual and organisational performance in PHC by identifying the relationship

    between organisational culture, leadership behaviour and job satisfaction.

    The Saudi Ministry of Health (MOH) has previously identified obstacles facing its health

    care system, including incompetent leaders, a workforce shortage, a high turnover rate, and

    the centralisation of power and decision-making. Further, the pattern of chronic disease is

    placing more pressure on the Saudi health care system. The country has one of the highest

    prevalence rates of chronic disease in the world. For example, Saudi Arabia has one of the

    worlds highest prevalence of diabetes (Shaw, Sicree, & Zimmet, 2010). For these reasons

    (the increase in the pattern of disease, the shortage of competent leaders, and the high

    turnover rate), PHC services are increasing in importance. However, to date, no research has

    been conducted into the status or effectiveness of PHC in Saudi Arabia. This study is a timely

    assessment of the present situation. The objectives of this study were: (1) to identify the

    effects of the demographic factors of PHC professionals on job satisfaction and

    organisational culture; (2) to identify the relationship between organisational culture and its

    influence on PHC professional satisfaction; (3) to describe how leadership behaviour affects

    job satisfaction of PHC professionals; (4) to identify the relationship between organisational

    culture and leadership behaviour; and (5) to design a comprehensive PHC development

  • IV

    managerial framework to address the evidence based management findings of this mixed-

    methods study.

    The study used an explanatory sequential mixed method design (QUAN-qual), to investigate

    and explore the relationships between organisational culture, leadership behaviour, and job

    satisfaction among 550 PHCC professionals in Saudi Arabia. The first phase involved a

    cross-sectional survey via a self-report instrument. The second phase used qualitative data to

    explain the findings derived from the initial phase through semi-structured interviews. The

    respondents completed a questionnaire and information sheet, indicating that they agreed to

    participate in the survey. Eleven participants were recruited through purposive sampling. A

    focus group was also conducted with six leaders (members of the PHC in Asir Region, Saudi

    Arabia). They discussed the findings of the mixed method approach and brainstormed the

    appropriate way to address the evidence drawn from this study.

    Reliable variables were operationalized from the questionnaire item scores. The demographic

    factors explained a significant proportion of the variance in job satisfaction and

    organisational culture. Leadership behaviour and organisational culture explained a

    significant proportion of the variance in job satisfaction; and organisational culture explained

    a significant proportion of the variance in leadership behaviour. Triangulation revealed that

    the findings of the qualitative study were generally consistent with the outcomes of the

    quantitative study. They also indicated that: (a) the PHCC professionals perceived a need for

    more training and development to satisfy their interests in updating their knowledge and

    skills; (b) some managers did not have the necessary leadership qualities/skills, and

    demonstrated a lack of understanding, implying that they required more training; and (c) the

    PHCC culture was hampered by bureaucracy, centralised authority, a lack of encouragement,

  • V

    a restriction of personal freedom, and limited decision making. The PHCC professionals

    highlighted the importance of human caring qualities, including praise and recognition,

    consideration, and support, with respect to their perceptions of job satisfaction, leadership

    behaviour, and organisational culture.

    As a consequence, a management framework was proposed to address these issues, which

    comprised two categories: outward looking (Macro focus) and inward looking (Micro focus)

    strategies. Future research is recommended to evaluate the implementation of the

    management framework and to expand the significance and the scope of the current study,

    based on a Plan-Do-Study-Act cycle.

  • VI

    Supervisory Team

    Principal Supervisor

    Professor Gerry FitzGerald MD, FACEM, FRACMA,

    FCHSM Director, Centre for Emergency and Disaster Management Faculty of Health School of Public Health Queensland University of Technology

    Associate Supervisor

    Professor Michele Clark BOccThy (Hons), BA, PhD School of Clinical Sciences Faculty of Health Queensland University of Technology

  • VII

    Table of Contents

    Abstract ............................................................................................................................................... III

    Table of Contents ............................................................................................................................... VII

    List of Figures ...................................................................................................................................... X

    List of Tables ....................................................................................................................................... XI

    List of Appendices ........................................................................................................................... XIII

    List of Abbreviations ....................................................................................................................... XIV

    Statement of Original Authorship ................................................................................................... XV

    DEDICATION ................................................................................................................................. XVI

    Acknowledgements ......................................................................................................................... XVII

    INTRODUCTION ....................................................................................................... 1 CHAPTER 1:

    1.1 Introduction ................................................................................................................................. 1

    1.2 Aim .............................................................................................................................................. 5 Objectives ...5

    1.3 Significance ................................................................................................................................. 6

    1.4 Thesis Outline ............................................................................................................................. 7

    CHAPTER 2 BACKGROUND.......................................................................................................... 9

    2.1 Saudi Arabia in general ............................................................................................................... 9 2.1.1 Saudi culture .................................................................................................................. 10 2.1.2 Demographics ................................................................................................................ 11 2.1.3 Economics ...................................................................................................................... 12 2.1.4 Saudi Arabia health care system .................................................................................... 13 2.1.5 Health system finance and expenditure .......................................................................... 18 2.1.6 Lines of health care system ............................................................................................ 21 2.1.7 Primary health care in Saudi Arabia .............................................................................. 22

    CHAPTER 3 LITERATURE REVIEW ......................................................................................... 29

    3.1 Job Satisfaction .................................................................................................

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