1.1 Research Background
Vietnam is a developing country with a population of approximately 90 million people (General statistic office, 2013). Along with rapid growth in other sectors, the healthcare sector is becoming more comprehensive and modern to meet the testing and treatment demands of the people.
According to official figures from the healthcare human resources administration (2013), there are 13,562 state and nearly 90,000 private institutions, (i.e. hospitals, clinics, and private pharmacies). The development of health services in Vietnam is the result of close cooperative partnership between public and private hospitals, with state-run hospitals playing a key role. The establishment of private corporate hospitals has contributed to solving overcrowding in state hospitals.
About health resources, nurses are essential resources to healthcare organizations. Nursing as a profession is a service whose core mission is caring and nurturing of human beings in their experiences of health and illness (Nassar, Abdou & Mohmoud, 2011). However, according to Phan (2000), in the past, the public, officials, and physicians stated that nurses who assisted physicians in putting the guidelines into practice often worked passively (1948-1989). But nowadays, nurses enjoy a higher level of independence and autonomy as they are allowed to take the initiative in many areas which help them become more positive and more confident, especially in private medical facilities (Phan, 2000).
In addition, the sustained profitability of an organization as well depend on its workforce job satisfaction (Lok & Crawford, 2004). Dissatisfaction with work can cause poor job performance, lower productivity, and staff turnover and is costly to organizations (Saari & Judge, 2004). These are serious problems in the healthcare environment. Because of the fact that losing these critical employees negatively impacts the bottom line of healthcare organizations in a variety of ways, including a decreased quality of patient care, loss of patients, increased contingent staff costs, increased nurse and medical staff turnover, increased staffing costs, as well
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as increased accident and absenteeism rates (Steven, 2009). Therefore, nurse job satisfaction is becoming a critical problem in any hospitals.
Recent reviews of the employee job satisfaction (Mosadeghrad &Yarmohammadian , 2006; Seo, Ko & Price ,2004) indicate that job satisfaction is correlated with received salaries, benefits, recognition, promotion, co-workers and management support, working conditions, type of work, job security, leadership style of manager, and demographic characteristics such as gender, marital, status, educational level, age, work tenure, and number of children. One of them, leadership style of manager plays important roles in job satisfaction of employees in any organizations (Mosadeghrad &Yarmohammadian, 2006).
Managers can utilize different leadership styles to lead, direct their employees, for example, autocratic, bureaucratic, laissez-faire, charismatic, democratic, participative, transactional and transformational leadership styles (Bass, 1981). In which, two of the most widely impacted to employees job satisfaction are transformational leadership style (TFL) and transactional leadership style (TSL) (Huber, 2006).
According to Burns (1978), transformational is the process in which leaders and followers raise one another to higher levels of motivation and morality. It includes the characteristics of the charismatic role modeling, inspirational motivation, intellectual stimulation and individual consideration (Bass & Avolio, 1994). These four characteristics also are generally abbreviated as the “Four I’s” (Avolio, Waldman & Yamarino, 1991). According to Bass (1985), TSL is the process which “pursues a cost-benefit, economic exchange to meet subordinates’
current material and psychic needs in return for contracted services” and “ approaches followers with an eye to exchanging one thing for another” (Burn, 1978). It includes the dimensions of contingent reward, active management by exception, passive management by exception and laissez-faire (Tales, 2010).
About nursing management situation in Vietnam, the investigation at the Department of medical management and Vietnam Nurse Association (2011) showed that nearly 50% of incumbent nursing managers are experts in professional knowledge but the majority has not yet developed good nursing management skills. The rest of nursing managers took nursing management classes before but they have not updated their knowledge and skills that go hand in
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hand with the changes in the mechanism of management and regulation in hospitals. Thus, nursing manager use which leadership styles and how use them have become vital, especially in an environment that is always changing (Dung, 2010).
Nevertheless, relevant researches to leadership style were mostly conducted in Western countries. But in fact that, each different country has different culture, so cultural factors have become influencing factors in leadership behaviors. Hofstede (1980) demonstrated that there are national and regional cultural groupings that affect the behavior of organizations and identified four primary dimensions of culture, which are power distance, uncertainly avoidance, individualism and collectivism, masculinity/ femininity. In which, power distance, or the degree to which individuals accept and believe that organizational, institutional, or societal power distributed unequally or equally (Carl, Gupta, & Javidan, 2004). In simpler terms, power distance measures the equality or inequality among people in a society. The power distance index shows that society with high power distance or low power distance. A high power distance culture means that inequalities of power and wealth have been allowed to grow within the society. On the other hand, low power distance cultures are less the differences between citizens’ power and wealth (Hofstede, 1980).
In the words of Hofstede (1980), the Vietnamese culture can be described as high power distance with PDI (power distance index) approximately 70-80 (Paul, 2009), high collectivism, moderate uncertainty avoidance, and high context (Quang, 1997; Ralston et al., 1999). According to Quang (1997), the high power distance characteristic is present in the daily life of Vietnamese as well as in business. In the family, sons and daughters have to obey parents’ orders. In organizations, there is a clear subordinate-superior relationship.
However, studies in Vietnam regarding to power distance were mostly conducted in economic sector and organization level, but no relevant research on this issue in health sector and individual level in Vietnam. So far, there has been no relevant research that tackles the relationship between leadership style and nurse job satisfaction under impacting of power distance in health setting, specifically in private sector. Hence, this study should shed some light into a novel issue relating to the moderating effects of power distance on the correlation between nurse job satisfaction and leadership style at private hospitals in Vietnam.
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1.2 Purpose
The purpose of this study is to investigate the relationship between transformational and transactional nurse manager leadership style and nurse staff job satisfaction.
It also will examine the effect of power distance on the relationship between transformational leadership, transactional leadership style and nurse job satisfaction.
1.3 Significance of the study
For Health Manager and Patient Outcome: The study will provide some
recommendations which can help hospital administrators and head nurses to build solid and supportive units. This is important because the culture of the unit and the quality of nursing staff affects every aspect of a nurse’s practice and the patients’ care. Health care managers and practitioners should be aware of the hardships that nurses face in trying to give quality care to patients.
For Policy Maker: This study will help administrators establish policies maker on changing worker characteristics, changing job characteristics, and working environment adjustment. It may also help in job placement strategies to retain more staff.
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1.4 Theoretical framework
This is the theoretical framework that will go along in the research:
Figure 1 Theoretical framework
According to the suggested model, leadership style: Transformational leadership style (TFL) and transactional leadership style (TSL) relates to nursing staff job satisfaction;
simultaneously, power distance also effects on the relationship between leadership style and nursing staff job satisfaction
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H1
H2
H3
H4
Transformational leadership styleTransactional leadership style
Job satisfaction Power
distance