Considerate Leadership as a Measure of Effectiveness in Medical and Higher Education: Analysis of Supervisory/Managerial Leadership

1. Organizational Cultures
An International Journal
ontheorganization.com
VOLUME 15 ISSUE 1
__________________________________________________________________________
Considerate Leadership as a Measure
of Effectiveness in Medical and Higher
Education
Analysis of Supervisory/Managerial Leadership
RANA ZEINE, CHERYL BOGLARSKY, EDWARD DALY, PATRICK BLESSINGER, MARY KURBAN, AND ALWYN GILKES

2. ORGANIZATIONAL CULTURES: AN INTERNATIONAL JOURNAL
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3. Organizational Cultures: An International Journal
Volume 15, Issue 1, 2014, www.ontheorganization.com, ISSN 2327-8013
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Considerate Leadership as a Measure of
Effectiveness in Medical and Higher Education:
Analysis of Supervisory/Managerial Leadership
Rana Zeine, Saint James School of Medicine, USA
Cheryl Boglarsky, Human Synergistics International, USA
Edward Daly, Community College of Rhode Island, USA
Patrick Blessinger, International Higher Education Teaching and Learning Association, USA
Mary Kurban, Christ the King Catholic School, USA
Alwyn Gilkes, Bronx Community College, USA
Abstract: Supervisory/Managerial Leadership characterizes many academic relationships within higher education
institutions. Students and trainees in many fields, including healthcare and graduate studies, often experience humiliation
and workplace aggression resulting from belittlement, bullying and abusive supervision which reflect defensive
organizational cultures. We and others have previously shown that higher education institutions, including medical
teaching centers, have detrimentally high levels of Aggressive/Defensive and Passive/Defensive cultural styles as
measured by the Human Synergistics International Organizational Culture Inventory®
(OCI®
& OCI-Ideal®
) Surveys.
Central to effective undergraduate, graduate and post-graduate training are supervisory/managerial leadership practices
which are negatively impacted by the current higher education operating cultures. In this paper, we analyze
Consideration, one measure of supervisory/managerial leadership that assumes empathy in supportive/participative
leadership communications. Faculty and administrators at public and private higher education institutions were surveyed
using the Human Synergistics International Organizational Effectiveness Inventory®
(OEI®
). Results revealed
Consideration scores undesirably below both the Historical Average and the Constructive Benchmark in for-profit and
not-for-profit higher education institutions. To improve the effectiveness of higher education institutions we recommend
changing the dynamics of internal professional interactions by promoting the (a) adoption of Constructive organizational
culture norms, (b) application of Individualized Consideration and Positive Affect Transferal behaviors from
transformational leadership theory, and (c) institutionalization of path-goal theory-based Considerate Leadership
supervision.
Keywords: Consideration, Supervisory Managerial Leadership, Organizational Effectiveness, Organizational Culture,
Higher Education, Medical Education
Introduction
iven that the purpose of higher education institutions is to facilitate the transfer of
expertise from those who have it to those who seek to acquire it, most relationships
between higher education professionals and their followers are structured to support
teaching, learning, training, and mentoring activities. The effectiveness of these professional
interactions can be analyzed by applying the broader standards of supervisory/managerial
leadership practices (Szumal 2001). Some notable examples of supervisory/managerial settings
that manifest during the course of higher education are (a) the supervision of graduate students
by mentoring professors, (b) the training of nurses by nursing supervisors, and (c) the
management of medical teams by attending physicians. Educators in such settings operate as
supervisory/managerial leaders who are often faced with the challenges of attaining multiple
goals concurrently, for example, the transferal of competencies in six integrated healthcare
domains including medical knowledge, patient care, research- or evidence-based medicine,
systems-based practice, professionalism, and communication skills (Crain, Alston et al. 2005)
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4. ORGANIZATIONAL CULTURES: AN INTERNATIONAL JOURNAL
Consideration as an Effectiveness Measure of Supervisory/Managerial
Leadership
One measurable characteristic of supervisory/managerial leadership is the degree of
Consideration that is afforded by the supervisor and perceived by the subordinate. The traditional
Consideration dimension refers to a people-oriented style of leadership that is both supportive
and participative, and in which supervisory interactions create a positive psychological
environment that supports goal attainment (Mulki and Jaramillo 2011; Ohio State Michigan
studies reviewed in Yukl 2012). Individualized Consideration, which is a component of
Transformational Leadership theory, also focuses on understanding the needs of followers
(supportive leadership) with a view to empowering them (developmental leadership) towards
attaining higher levels of potential (Bass, Avolio et al. 1996; Avolio and Bass 1999; Rafferty and
Griffin 2006). To recognize and elevate follower needs, Individually Considerate leaders show
empathy and concern for the individual needs of their followers (Bass, Avolio et al. 1996).
Another component of Transformational Leadership theory is Charisma, which is a factor that
provides followers with an energizing sense of purpose and enhances their identification with the
leader and the leader’s vision (Avolio and Bass 1999; Judge and Bono 2000). Studies have
demonstrated that leader charisma is positively associated with followers’ positive affect, and
negatively associated with followers’ negative affect (Erez, Misangyi et al. 2008).
The Considerate leader is further informed by the Path-Goal theory of supervision, which
focuses on how formally appointed superiors can affect the motivation and performance of their
subordinates by ensuring that they “experience intrinsic satisfaction” as a result of attaining work
goals (House 1996).
Unfortunately, the majority of higher education professionals have never had opportunities
to reflect on either Bass’s Transformational Leadership theory, or House’s Path-Goal theory. In
addition, supervisors, subordinates and students may be resigned to a culture of bullying as a
result of having been exposed to bullying in their past, or of feeling powerless to change
prevailing institutional culture and policies. Studies indicate that bullying is a learned behavior
that could be perpetuated by overly competitive work environments and organizational reward
systems that encourage overly aggressive behaviors (Lewis 2006). This lack of sensitivity,
combined with a lack of awareness of the importance of Consideration, Individualized
Consideration, and Considerate Leadership approaches to achieving the goals of education, has
led to a culture of tolerance towards chronic incivility behaviors in higher education institutions.
Incivility Problems in Higher Education
Sadly, the void created by the paucity of supervisory/managerial Consideration can foster the
emergence of a spectrum of hostile behaviors classified as incivility, humiliation, intimidation,
mistreatment, academic harassment, bullying, abuse and workplace aggression or violence
(Morse 2010; Hershcovis 2011). In schools, bullies target anyone who has a trait that is different
from theirs. Abusive supervision interferes with goal attainment by (a) negatively influencing the
followers’ perceptions of interactional justice, (b) significantly diminishing their beliefs that they
are engaged in meaningful work, and (c) considerably weakening their levels of organizational-
based self-esteem (Rafferty and Restubog 2011). Indeed, students’ emotional responses to
experiences of either distributive, procedural or interactional injustice include feelings of anger,
frustration, powerlessness, stress, embarrassment, disgust and a sense of having been cheated
(Horan, Chory et al. 2010).
Workplace bullying has been shown to be more prevalent in stressful working environments
especially those that are characterized by intense interpersonal friction and destructive leadership
styles (Hauge, Skogstad et al. 2007). Workplace bullying involves negative social acts and
practices that are repeatedly and regularly directed at a target individual who may feel badgered,
2

5. ZEINE ET AL.: CONSIDERATE LEADERSHIP AS A MEASURE OF EFFECTIVENESS IN EDUCATION
insulted, humiliated, offended, intimidated, harassed, or socially excluded, and who perceives
having no recourse to retaliate (Hauge, Skogstad et al. 2007). Examples of nursing faculty
behaviors that have been perceived by nursing students as bullying include the deliberate
provision of punitive assignments or bad grades, and the setting of unmanageable workloads or
unrealistic deadlines (Cooper, Walker et al. 2011).
Many graduate students find that they are highly vulnerable to those who would use their
position or power to intimidate or harass them (Morse 2010). Examples of issues that are brought
to the attention of the Ombudsman by graduate students include (a) concerns that an adviser is
delaying their student’s degree progress in order to retain a cheap source of labor, (b) situations
in which a faculty member is taking advantage of a student research assistant who fears losing
their visa status, or (c) one trainee is being given credit for another student’s work (Morse 2010).
Medical Students Experience Workplace Aggression
The use of aversive methods in medical education has left a "transgenerational legacy" of
mistreatment perpetuated by misguided efforts to achieve reinforcement of learning (Baldwin,
Daugherty et al. 1991; Kassebaum and Cutler 1998). Educators have used public belittlement,
intimidation and bullying of medical students and postgraduate trainees as tools to ‘teach through
humiliation’ (Spencer and Lennard 2005). Despite the knowledge that humiliation undermines
students’ self-esteem and is an unnecessary and preventable cause of harm (Rosenberg and Silver
1984), the view that learners somehow ‘benefit’ from being humiliated by their instructors
continues to be a subject of discussion in the medical education literature (Cookson 2006).
Surveys of medical students and postgraduate trainees reveal that the perpetrators of adverse
experiences commonly include faculty members, senior doctors and nurses who do not refrain
from yelling, shouting, swearing, hitting, pushing, threatening, punishing, demeaning or
degrading acts. In one medical school in Chile, medical students reported that workplace
aggression negatively impacted their physical and mental health, social and family life, quality of
work, image of physicians and level of attraction to the medical profession (Maida, Vásquez et
al. 2003). In a nationwide study of four medical schools in New Zealand, medical students
affected by episodes of humiliation or degradation reported consequently avoiding the
department or individual perpetrator(s) (67%), seeking help or support from others (49%),
turning away from subspecialties that tolerate abusive behaviors (34%), becoming increasingly
withdrawn or isolated (26%), considering quitting medicine (16%) and taking time off from
medical school (5%) (Wilkinson, Gill et al. 2006). In a longitudinal study of sixteen medical
schools in the United States, medical students who reported having been harassed or belittled
differed significantly by subspecialty (Table 1), and were significantly more likely to suffer from
stress, depression, binge drinking, suicidal ideation, suicide attempts and feelings that their
faculty did not care about them (Frank, Carrera et al. 2006).
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6. ORGANIZATIONAL CULTURES: AN INTERNATIONAL JOURNAL
Table 1: Percentages of medical students, surveyed at 16 US medical schools, who experienced
belittlement and harassment from residents or clinical professors
Subspecialty Residents Clinical Professors
Belittlement Harassment Belittlement Harassment
Psychiatry 77 % 38 % 66 % 21 %
Family medicine 75 % 32 % 69 % 30 %
General Internal medicine 72 % 28 % 65 % 25 %
Emergency medicine 71 % 30 % 64 % 22 %
Surgery 70 % 28 % 60 % 24 %
Pediatrics 73 % 22 % 67 % 20 %
Public health, preventive
medicine, urology, undecided, other
69 % 27 % 62 % 22%
Anesthesiology, Pathology or
Radiology
70 % 27 % 60 % 16 %
Obstetrics & Gynecology 71 % 24 % 58 % 16 %
Total 71 % 27 % 63 % 21 %
Data are adapted from “Experiences of belittlement and harassment and their correlates among
medical students in the United States: longitudinal survey,” by Frank, E. et al., 2006, BMJ, 333(7570)
In a cross-sectional survey of six medical schools in Japan, 68% of respondents reported
encountering some type of medical student abuse, however, only 8% of those affected had
formally reported the adverse incidents to authorities (Nagata-Kobayashi, Sekimoto et al. 2006).
The majority of medical students had doubts that reported problems would be dealt with fairly,
and they consciously refrained from asserting their rights for fear of retribution and/or conflict
escalation that could jeopardize their academic standing or interfere with the attainment of their
career goals (Nagata-Kobayashi, Sekimoto et al. 2006). A cross-sectional survey of six medical
colleges in Pakistan revealed that among the 52% of students who had faced bullying or
harassment, the frequencies of adverse experiences were less than once a month in 25%, once a
month in 16%, and once a week in 11% of the cases (Ahmer, Yousafzai et al. 2008). In addition
to experiencing verbal abuse (57%), physical abuse (5%) and written abuse (2.5%), medical
students in Pakistan encountered behavioral gestures that they perceived as representing bullying
or harassment (26%), and a proportion felt that they had been either deliberately ignored (16%)
or excluded (11%) (Ahmer, Yousafzai et al. 2008). Another study documented the prevalence of
unfair practices by residents, colleagues and seniors who took credit for work done by medical
students (Shoukat, Anis et al. 2010).
Organizational Cultures with Defensive Styles and Workplace Bullying
Research instruments have been developed to explore organizational culture models qualitatively
and quantitatively (Jung, Scott et al. 2009). Organizations with Aggressive/Defensive cultures are
volatile because they value coercion, confrontation, criticism, and overconfidence, and their
members suffer from disempowerment, cynicism, disrespect and reliance on security-preserving
mechanisms such as the punishment and blaming of others (Cooke and Rousseau 1988).
Organizations with Passive/Defensive cultures are vulnerable because conflicts tend to remain
unresolved as members lose their motivation, remain noncommittal and resort to self-protecting
mechanisms such as accommodation, avoidance, withdrawal and quitting (Szumal 2003). By
contrast, Constructive cultural styles support sustainability as organizational members thrive
through creativity, flexibility, consultation, communication, sharing of knowledge and insight,
reason, coordination, cooperation and behaviors that enhance self and develop others (Cooke and
Szumal 2000). To analyze the organizational culture in higher education, faculty, administrative
directors, department chairs and deans at institutions worldwide were surveyed using the Human
4

7. ZEINE ET AL.: CONSIDERATE LEADERSHIP AS A MEASURE OF EFFECTIVENESS IN EDUCATION
Synergistics International Organizational Culture Inventory®
(OCI®
) and OCI-Ideal®
surveys
(Zeine, Boglarsky et al. 2011). The Ideal cultural profile scored above the 95th
percentile for
Constructive styles, promoting Achievement (98%), Self-Actualization (98%), Affiliation (92%)
and Humanistic-Encouraging (98%) norms (Zeine, Boglarsky et al. 2011). By contrast, Current
operating cultures manifested excessively high levels of Aggressive/Defensive styles, evidenced
by Oppositional (67%), Power (50%), Competitive (63%) and Perfectionistic (52%) behavioral
norms; and similarly high scores for Passive/Defensive styles, evidenced by Approval (55%),
Conventional (54%), Dependence (55%) and Avoidance (59%) normative expectations (Zeine,
Boglarsky et al. 2011). Indeed, Constructive styles were below the 29th
percentile on the 2000-
2001 OCI®
profile for the Ohio State University Medical Center, whereas Avoidance (91%) and
Oppositional styles were concurrently predominant (Sanfilippo, Bendapudi et al. 2008).
All types of workplace aggression, including bullying, social undermining, abusive
supervision, incivility, emotional abuse, interpersonal conflict and violence, are mediated
through blame attribution, affect and forms of injustice (Hershcovis 2011). It is believed that “the
norms and values within an organization, as well as the type and quality of the organizational
communication patterns, may constitute some of the essence of the bullying problem”
(Matthiesen and Einarsen 2010). Moderators of workplace aggression include perceived intent,
perceived intensity, frequency, perceived invisibility (covert versus overt), and formal power
dynamic in the perpetrator-victim relationship (Hershcovis 2011).
In a survey conducted in Belgium on the quality of working life among employees within
the textile industry and financial services, job insecurity was found to be associated with reports
of workplace bullying by both targets and perpetrators, and the relationship between job
insecurity and workplace bullying was stronger under conditions of high perceived employability
(De Cuyper, Baillien et al. 2009). Furthermore, evidence has indicated that targets’ reporting of
bullying are positively correlated with job demands, and inversely correlated with job resources
over time (Baillien, Rodriguez-Munoz et al. 2011).
In the healthcare industry there is a history of tolerance and indifference to intimidating, and
disruptive behaviors because unprofessional practices are believed to be excusable when dealing
with ‘high stakes’ situations, coping with fear of litigation, and ‘surviving’ within embedded
hierarchies (Beck, Hackett et al. 1997; Joint Commission 2008).
It is important to note that both victims and non-victims of bullying experience a poor
interpersonal work environment where bullying occurs (Skogstad, Torsheim et al. 2011). Within
departments of Norwegian organizations from financial institutions, fish farming, healthcare
sector, governmental and municipal agencies, media, offshore industries, research, higher
education institutions, passenger transport and manufacturing companies, bullying observed by
respondents, between January 2000 and January 2006, strongly correlated, at the within-group
level, with social climate (organizational culture), leadership behavior (supervisory support,
empowering leadership, fair leadership) and role conflict (Skogstad, Torsheim et al. 2011).
An ecological model of workplace bullying has been described consisting of four
interrelated systems: the microsystem containing the bully and the target, the mesosystem
including the workgroup and its supervisor/manager, the exosystem provided by the
organization, and the macrosystem formed by the society (Johnson 2011). Antecedent factors
flow from the outer macrosystem through the inner exo- and meso- systems creating conditions
conducive of bullying within the microsystem (Johnson 2011). In this paper, we compared
perceptions of Consideration among higher education institutions to corporate benchmarks.
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8. ORGANIZATIONAL CULTURES: AN INTERNATIONAL JOURNAL
Methods
Participants in this study were 52 higher education administrators and teaching faculty who
individually completed the Human Synergistics Organizational Effectiveness Inventory survey
(OEI®
, web-based version, http://www.humansynergistics.com/) (Cooke 1997). Respondents
were affiliated with institutions located in at least 16 countries in North America, Europe, India,
Australia, Latin America, Africa and the Middle East (Human-Synergistics 2012). The OEI®
evaluates 43 effectiveness measures consisting of two factors relevant to mission articulation and
customer-service-focus; 29 components of systems, structures, human resources,
communications and supervisory leadership, considered to be ‘causal factors’; and 12
performance outcomes (Cooke and Szumal 2000; Szumal 2001).
Demographic data and score results for one measure of supervisory/managerial leadership,
Consideration, are presented and analyzed in this paper (Figure 1). Consideration is a relational
leadership skill which pertains to the extent of supportiveness and consideration that
supervisors/managers exhibit towards their subordinates.
The mean scores and standard errors were computed and plotted for total respondents (n=52)
and for eight subgroups of faculty (n=25), administrators (n=20), female (n=25), male (n=26),
for-profit-public (n=4), for-profit-private (n=10), not-for-profit-public (n=30) and not-for-profit-
private (n=8) institutions (Figure 1). OEI®
results were compared to the Historical Average (50th
percentile), which is the median of the OEI®
responses of members from 1084 organizational
units, and to Constructive Benchmarks, which are based on the median of OEI®
results for 172
organizational units with predominantly Constructive operating cultures (Human-Synergistics
2012). The Constructive Benchmark score was greater than the Historical Average score, and any
results for Consideration falling below the value for the Historical Average were considered
undesirable. One-way ANOVA was used to assess the statistical significance of inter-subgroup
differences.
Results
Demographics of Respondents
Participants were affiliated with higher education institutions in the United States (n=23), India
(n=4), United Kingdom (n=3), France (n=2), Australia (n=2), Canada, Wales, Spain, Denmark,
Greece, Macedonia, New Zealand, Ethiopia, Egypt, Jordan, Costa Rica and undetermined
countries. Institutional levels were 56% Doctorate-granting universities, 19% Master’s
colleges/universities, 13% Bachelor’s colleges, 6% Associate’s colleges, 2% Special Focus and
4% undetermined. The age distribution of the participants was widely spread with 56% falling in
the 40-59 years age bracket, 21% being older than 60 years, and 17% being younger than 39
years of age. The professional roles of respondents were faculty/professor (48%), director (19%),
associate dean (6%), chair (4%), dean (4%), provost/dean academic affairs (4%), president (2%)
and undetermined (13%). 15% had spent more than 15 years at their current institutions, while
6% had spent 10 to15 years, 19% had spent 6 to10 years, 23% had remained for 4 to 6 years,
19% had spent 2 to 4 years, and 6% had been affiliated for 1 to 2 years, while 6% had spent 6
months and 4% less than 6 months. There were equivalent numbers of men and women
participants (1:1 male to female ratio).
Consideration Levels are Undesirable in Higher Education Institutions
Scores for Consideration were below the Historical Average (50th
percentile, 4.03) and the
Constructive Benchmark (4.36) for total respondents (mean 3.69 ± 0.17 SE), and for faculty
(mean 3.76 ± 0.24 SE) , administrators (mean 3.80 ± 0.28 SE), male (mean 3.62 ± 0.24 SE) and
6

9. ZEINE ET AL.: CONSIDERATE LEADERSHIP AS A MEASURE OF EFFECTIVENESS IN EDUCATION
female (mean 3.80 ± 0.25 SE) subgroups as shown in Figure 1. Minimally higher scores were
obtained for the administrators as compared to the faculty subgroups; and a trend for higher
scores was noted in the female as compared to the male subgroups (p-value = 0.598 female vs.
male). However, statistical significance was not reached for any of the inter-subgroup differences
(using one-way ANOVA).
Mean scores for private not-for-profit (mean 3.71 ± 0.34 SE), public not-for-profit (mean
3.60 ± 0.24 SE) and private for-profit (mean 3.77 ± 0.36 SE) subgroups also fell below the
Historical Average, with the public not-for-profits (n=30) scoring lowest (Figure 1). By contrast,
the mean score for the small (n=4) public for-profit subgroup (mean 4.08 ± 0.92 SE) reached the
Historical Average and showed wide variation the rose above the Constructive Benchmark
(Figure 1). The differences between the public for-profit and the other three institutional type
subgroups did not reach statistical significance (p-value = 0.914 public for-profits vs. public not-
for-profits).
Figure 1: Consideration measure of supervisory/managerial leadership in higher education institutions. OEI®
Consideration Mean score ± standard error (SE) for total respondents, and for female, male, faculty, administrators,
public for-profit, private for-profit, public not-for-profit and private not-for-profit subgroups compared to the Historical
Average and the Constructive Benchmark. Except for the small public for-profits subgroup, the mean scores fall below
both the 50th
percentile and the Constructive Benchmark for Consideration.
Discussion
In this study, pooled scores on the Consideration dimension of leadership, obtained from faculty
and administrators, revealed a definite vulnerability of higher education institutions to tolerate
supervisory/managerial practices that are not sufficiently people-oriented. Perceptions of
Consideration were undesirably low in for-profit and not-for-profit institutions, and lowest in the
male subgroup, pointing to the prevalence of inadequate levels of developmental leadership and
supportive leadership styles in higher education institutions (Figure 1) (Rafferty and Griffin
2006).
Our findings of inadequate Consideration levels are symptomatic of systemic incivility
problems that are compromising the effectiveness of higher education (Figure 1). When medical
7

10. ORGANIZATIONAL CULTURES: AN INTERNATIONAL JOURNAL
students, as subordinates, describe being subjected to hurtful experiences by their superiors, they
are highlighting the poor quality of that supervisory/managerial relationship. Subgroup analysis
revealed notable agreement among faculty vs. administrators, males vs. females, private vs.
public and for-profit vs. not-for-profit organizations in Consideration scores (Figure 1). Our
findings of low Consideration levels are consistent with our results showing undesirably high
levels of Job Insecurity in Higher Education institutions (data not shown, manuscript in
preparation), since Job Insecurity is negatively correlated with developmental leadership
(Individualized Consideration) and is an antecedent factor for supervisory abuse (Rafferty and
Griffin 2006). Furthermore, our findings are also consistent with our results revealing
undesirably low levels of Customer Service Focus in higher education institutions (Zeine,
Palatnick et al. 2014).
Understanding Resistance to Change
While adapting to change, it is natural to transition through psychological phases beginning with
Denial and progressing through periods of Resistance and Exploration before attaining
Commitment (Jaffe and Scott 2010). Change occurs when something either “starts or stops, or
when something that used to happen in one way starts happening in another” (Bridges 1986).
Resistance to change develops because of the difficulty people have with “letting go of who they
were and where they have been” which can be experienced as a disengagement from their old
identity (Bridges, 1986, p.25). Overcoming this “Ending Phase” leads into a "Neutral Zone"
where reorientation and reintegration occur, sparking a phase of “New Beginnings” where people
come to the realization that they have to make changes (Bridges, 1986).
Reasons for resisting proposed changes to policies, procedures, roles or responsibilities
include human nature, fears and imagined threats (Caruth, Middlebrook et al. 1985). Once
employees become accustomed to a situation, even if it is uncomfortable and undesirable, they
tend to strongly resist any suggestions for changing it (Caruth, Middlebrook et al. 1985). Even
when a proposed change is likely to be beneficial for an individual’s circumstances, resistance
mounts due to “fear of the unknown, fear of reduced job security, fear of suffering economic
loss, fear of reduced job status, or fear of change in work group relationships” (Caruth,
Middlebrook et al. 1985).
Creating Readiness for Change
To reduce delays and minimize losses in productivity, change managers endeavor to assist in
overcoming Denial and Resistance by communicating the importance and details of the proposed
change, and by listening sympathetically, acknowledging, and supporting people in experiencing
their difficult feelings (Jaffe and Scott 2010). In the Exploration stage, the change has been
accepted and change managers can assist in focusing energies, discovering possibilities, choosing
options and seeking ways to make the change successful (Jaffe and Scott 2010). Once people
have mastered the new ways, gained confidence in their new skills and learned to succeed within
their new realities, they are in Commitment, and begin to focus their attention externally on the
needs of their team and organization (Jaffe and Scott 2010).
Creating readiness for change requires the delivery of a persuasive change message designed
to influence five key beliefs that organizational members hold about the change (Armenakis and
Harris 2009). Discrepancy is the belief that change is needed in order to move the organization
from its current state towards a perceived ideal, appropriateness is the belief that the proposed
change is the right one for the circumstances, efficacy reflects their level of confidence in the
feasibility of the change, principal support is the perception that there is commitment to the long-
term success of the change at the leadership levels of the organization, and personal valence is
the conviction that the change will be beneficial (Armenakis and Harris 2009).
8

11. ZEINE ET AL.: CONSIDERATE LEADERSHIP AS A MEASURE OF EFFECTIVENESS IN EDUCATION
To transform organizational culture and performance, the Ohio State University Medical
Center (1) selected a small leadership team consisting of appointees from academic, clinical and
administrative units, (2) assessed challenges and opportunities by evaluating organizational
culture using the Human Synergistics Organizational Culture Inventory, OCI®
Survey, (Cooke
and Lafferty 1987; Szumal 2003), and soliciting formal and informal input on organizational
structure, function, and performance, (3) set expectations for a high degree of collaboration
within and among units, and clearly communicated a shared vision, (4) aligned medical school,
practice plans, and hospital functional units; education, research, clinical and support service
missions, (5) engaged faculty, staff and external constituents in driving that change, (6)
developed leadership skills through retreats and educational programs, implemented “360”
leadership scorecards and mentoring, and (7) defined strategies and established criteria for
tracking outcomes measures (Sanfilippo, Bendapudi et al. 2008). As compared to their
organizational culture profile in 2000-2001, the Ohio State University Medical Center’s 2005-
2006 OCI®
profile revealed a rise in Constructive styles to the 62nd
percentile, and a drop in the
Passive/Defensive Avoidance style from the 91st
to the 61st
percentile, concomitant with an 8%
increase in student satisfaction rates (Sanfilippo, Bendapudi et al. 2008).
Recommendations
To raise the levels of Consideration in Higher Education Institutions, we recommend the
following practices:
I. Monitor employee well-being, job satisfaction and student satisfaction regularly
and address the feedback systemically. Feedback Surveys can be designed to
monitor program-specific concerns. Levels of stress, fatigue, emotional exhaustion,
depersonalization, depression and quality of life can be evaluated using The
Medical Student Wellbeing Index (MSWBI) which was developed by researchers at
the Mayo Clinic College of Medicine (Dyrbye, Szydlo et al. 2010). Higher
Education institutions can choose to address such concerns systemically, for
example, the ombudsman at the University of Minnesota is using a systems
approach and data collected in a survey of more than 10,000 graduate students to
implement a campus-wide change initiative aimed at establishing a shared vision
for a positive academic and work environment that would be free from offensive,
hostile and intimidating or toxic behavior (Morse 2010).
II. Improve Professional Standards. As part of the Standards Improvement Initiative,
The Joint Commission introduced requirements for all accreditation programs in the
United States to ensure that (a) healthcare organizations define disruptive and
inappropriate behaviors in their code of conduct, (b) healthcare leaders create and
implement a process for effective management of disruptive and inappropriate
behaviors, and (c) healthcare educators/managers evaluate and monitor medical
staff professionalism and interpersonal skills as competencies to be addressed in the
credentialing process (Joint Commission 2008).
III. Introduce Active Learning. Academic achievement has been positively correlated
with deep understanding and with strategic approaches to learning that are
motivated by assessment, and negatively correlated with surface (memorization)
learning approaches (Reid, Duvall et al. 2007). The adoption of student-centered
and competency-based reforms to medical education continues to positively impact
medical student satisfaction and team-building skills (Mennin, Gordan et al. 2003;
Kyong-Jee and Changwon 2010). A study conducted in four medical schools in
Turkey demonstrated that students who experienced a learner-centered curriculum
exhibited improved metacognitive awareness and self-regulated learning skills
9

12. ORGANIZATIONAL CULTURES: AN INTERNATIONAL JOURNAL
(Turan, Demirel et al. 2009). One study from the US described the transformation
over ten years of an evidence-based medicine curriculum from a teacher-centered
approach to a learner-centered, and patient centric approach (Aiyer and Dorsch
2008).
IV. Raise awareness about the benefits of Considerate Leadership in education. To raise
more considerate educators, we call for the development of training programs in
leadership skills for educators, students, and all those who are assigned to
supervisory roles in higher education institutions. The ‘transferal of positive affect’
component of Charisma, and expressions of enthusiasm, humor and empathy, have
been shown to enhance the effectiveness of interprofessional education (Lindqvist
and Reeves 2007; Erez, Misangyi et al. 2008). Supervisors need to become familiar
with the types of statements that followers use to describe leaders who exhibit
individualized consideration (Boyette 2006).
V. Adopt Constructive Cultural Styles throughout the Higher Education
Institution. Design and implement a systematic change initiative to replace
Defensive styles with Constructive styles at all academic and administrative levels
(Sanfilippo, Bendapudi et al. 2008; Zeine, Boglarsky et al. 2011).
Conclusion
The defensive organizational cultures prevailing in higher education institutions are
compromising organizational effectiveness as measured by supervisory/managerial leadership.
There is a need for improving the levels of Consideration encompassing developmental and
supportive leadership styles in higher education institutions. Changes in organizational culture,
policies and standards are needed to reverse long-ingrained behavioral norms and to improve the
effectiveness of graduate, medical and professional higher education.
10

13. ZEINE ET AL.: CONSIDERATE LEADERSHIP AS A MEASURE OF EFFECTIVENESS IN EDUCATION
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ABOUT THE AUTHORS
Dr. Rana Zeine: Associate Professor, Basic Medical Sciences, Bonaire, Saint James School of
Medicine, HRDS, Park Ridge, IL, USA
Dr. Cheryl Boglarsky: Human Synergistics International, Plymouth, Michigan, USA
Dr. Edward Daly: Community College of Rhode Island, Warwick, Rhode Island, USA
Dr. Patrick Blessinger: International Higher Education Teaching and Learning Association,
New York, USA
Dr. Mary Kurban: Christ the King Catholic School, Los Angeles, California, USA
Dr. Alwyn Gilkes: Bronx Community College, New York, USA
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16. Organizational Cultures: An International Journal
is one of four thematically focused journals in the
collection of journals that support The Organization
knowledge community—its journals, book series,
conference and online community.
The journal explores success factors in the
management of organizational culture in responsive,
productive and respected organizations.
As well as papers of a traditional scholarly type, this
journal invites case studies that take the form of
presentations of management practice—including
documentation of organizational practices and
exegeses analyzing the effects of those practices.
Organizational Cultures: An International Journal is a
peer-reviewed scholarly journal.
ISSN 2327-8013