BUSI 502 Week 7 Leadership Research Paper Example

Serving at Scale: An Interview-Based Study of Servant Leadership in a Large Health System

Introduction

When a regional health system closed one of its smaller hospitals, the senior vice president of operations who led the closure spent the last week in the building's cafeteria, eating lunch with any employee who wanted to talk. "I made the decision," she said in our interview, "so I owed them the chance to tell me what it cost them." That image, a senior executive making a painful decision and then staying to bear its consequences, captures the question this paper explores: what does servant leadership look like in a large organization, where leaders are far from most of the people they lead and must make decisions that harm some to protect many?

This paper examines that question through an interview with Diane Carver, a composite senior vice president of operations at a health system of about 14,000 employees, and through the research literature on servant leadership. It argues that her practice matches the research's central claims, that servant leaders build trust, voice and a culture of service, and adds a theme the literature treats less fully: that hard decisions, made openly and carried personally, can themselves be acts of service.

Literature Review

Origins and Definitions

Greenleaf (1977) introduced the modern idea of servant leadership, insisting that the true servant leader begins with the wish to serve and only then chooses to lead, and proposing that such leadership be judged by whether the people served flourish. Later scholars developed the idea into a construct. Reviewing three decades of work, van Dierendonck (2011) proposed six key characteristics, including empowering and developing people, humility, authenticity and stewardship, and argued that servant leaders are distinguished by putting followers' development ahead of their own standing. Barbuto and Wheeler (2006) developed an early measure distinguishing dimensions such as altruistic calling, emotional healing, wisdom, persuasive mapping and organizational stewardship.

Measurement

Liden et al. (2008) built a seven-part scale, now among the most used, covering a leader's attention to followers' emotional needs, contribution to the wider community, sound judgment, sharing of power, investment in followers' careers, readiness to put their needs first and personal integrity. Sendjaya et al. (2008) added dimensions such as voluntary subordination and transcendental spirituality, recognizing that many servant leaders root their service in faith. These measures made it possible to test servant leadership's effects. They also clarified what servant leadership is not. Unlike transformational leadership, which centers on the organization's goals and inspires followers toward them, servant leadership centers first on the followers themselves, trusting that people who grow will serve the organization well. Unlike a purely ethical leadership model, it asks not only whether leaders avoid wrongdoing but whether they actively put others first.

Outcomes and Mechanisms

Research links servant leadership to a range of outcomes. Ehrhart (2004) found that servant leadership was related to a unit's procedural justice climate and, through it, to unit-level organizational citizenship behavior. Walumbwa et al. (2010) found that servant leadership influenced employees' attitudes and citizenship behavior through procedural justice and service climates. In a study of bank teams, Schaubroeck et al. (2011) showed that servant leadership raised team performance largely by building trust grounded in emotional bonds. Neubert et al. (2008) found that servant leadership was associated with a promotion focus in employees, which in turn related to helping and creative behavior. Chiniara and Bentein (2016) found that servant leadership predicted individual performance through the satisfaction of employees' needs for autonomy, competence and relatedness. At the level of the unit, Liden et al. (2014) showed that servant leaders built a serving culture that related to restaurant performance and to employees' own service, and Hunter et al. (2013), studying retail stores, reported that servant leaders' staff were more inclined to help coworkers and less inclined to leave.

Comparisons and Critiques

Servant leadership overlaps with other positive leadership models, which raises the question of whether it adds anything distinct. In their meta-analysis, Hoch et al. (2018) set servant, ethical and authentic leadership against transformational leadership and found that only servant leadership added substantially to the prediction of employee outcomes. A second synthesis by Lee et al. (2020) reached a similar conclusion across a larger body of studies and examined the conditions and pathways through which servant leadership operates. At the top of organizations, Peterson et al. (2012) connected founders' and chief executives' service orientation with how well their companies performed, and showed that self-absorbed executives rarely led that way. Owens and Hekman (2012) found that humble leaders legitimized followers' growth by modeling it themselves. Critics have noted weaknesses: Eva et al. (2019), reviewing 285 articles, called for clearer definitions, better measures and stronger research designs, and observed that relatively little research examines how servant leaders handle difficult decisions. That gap is where this paper's interview offers something.

Method

Diane Carver was chosen because she leads in a large organization, has a reputation among colleagues for developing people, and describes her leadership in terms of service. The interview lasted about seventy minutes by video and followed a semi-structured guide of ten questions, asking about her definition of leadership, how she makes decisions that affect many people, how she develops successors, how she handles failure and feedback, and what practices sustain her. Notes were typed during the interview and reviewed the same day, then grouped into themes and compared with the literature and the course texts. The guide's questions included:

• How would you describe your role as a leader in a few sentences?
• Tell me about a decision that hurt people you lead. How did you make it and carry it out?
• How do you learn what employees several levels below you are experiencing?
• Who could do your job if you left tomorrow, and how did they get ready?
• What do you do when someone tells you that you are wrong?
• What practices keep you going in this role?

Follow-up questions asked for specific examples whenever an answer was general, a practice that helps interviews yield evidence rather than self-description.

Findings

Theme 1: An Identity That Makes Service Possible

Asked what makes servant leadership possible in a role with so much authority, Carver answered, "I stopped needing the job to tell me who I am." She described a period early in her career when promotions defined her worth, and a later realization that her worth came from God, not from her title. That shift, she said, changed how she responded to criticism: "When my value isn't on the line, I can actually hear what people are telling me." Blanchard et al. (2016) treat this kind of security as the soil in which service grows, the opposite of the self-protection that turns leaders inward, and Owens and Hekman (2012) found that humble leaders are able to acknowledge limits because their identity does not depend on appearing infallible.

Theme 2: Listening That Invites Voice

Carver holds monthly open forums at each hospital and answers every question in writing within a week. "If I don't answer, they stop asking," she said. That practice reflects the mechanism Schaubroeck et al. (2011) found, trust built through the leader's consistent care, and the climate of fair process that Ehrhart (2004) and Walumbwa et al. (2010) linked to citizenship behavior. Her written answers also make her listening visible across a large system where most employees never meet her. She described one answer that led to a change: a nurse asked why night-shift staff could not attend daytime training, and the system added recorded sessions within a month. Visible follow-through of this kind is what turns a listening session into voice, because employees learn that speaking up changes things.

Theme 3: Developing Successors

Carver keeps a list of three people who could do her job and meets with each quarterly. "If I left tomorrow and the system suffered, I failed," she said. This matches the developing-others dimension in Liden et al. (2008) and the need satisfaction that Chiniara and Bentein (2016) found drives performance under servant leaders, especially employees' sense of competence. It also echoes the test proposed by Greenleaf (1977) that those served should grow. Two of the three people on her list had been promoted to hospital president roles within the past three years, and she counted their success as her own measure of performance.

Theme 4: Building a Serving Culture

Carver asks every manager who reports to her to begin team meetings with a story of a colleague who served a patient or coworker well. Over time, she said, the stories became the culture: people began doing things they hoped would be told. Liden et al. (2014) found that servant leaders shaped exactly this kind of serving culture, which then influenced employees' own behavior, and the retail study by Hunter et al. (2013) observed more mutual help among servant leaders' employees. Carver added that stories work in a large system because they travel where she cannot.

Theme 5: Hard Decisions as Service

The hospital closure was the hardest decision of Carver's career. The smaller hospital had lost money for years, and keeping it open threatened services across the system. "Serving the 14,000 meant hurting the 400," she said, "and I could not pretend otherwise." She insisted on four things: telling employees before the public, offering every employee a position elsewhere in the system, funding retraining for those who could not relocate, and being present personally through the last week. The research says little about this side of servant leadership, as Eva et al. (2019) note, but Collins (2001) found that great companies' leaders combined humility with fierce resolve to do what the organization needed. Carver's practice suggests that servant leadership does not avoid hard decisions; it changes how they are made and carried. Her four commitments, honesty first, a place for everyone who wanted one, help for those who could not move and her own presence, each put the people bearing the cost at the center of the plan. Months later, she said, several employees from the closed hospital told her they disagreed with the decision but trusted how it was handled.

Theme 6: Habits of Renewal

Carver begins each workday with thirty minutes of prayer and Scripture before opening email, and meets monthly with two other executives who hold her accountable. Blanchard and Hodges (2003) describe solitude, prayer, Scripture and supportive relationships as the habits that renew a servant leader. Carver described these habits as what kept the closure from making her either hard or paralyzed. During the closure, her accountability partners asked each month whether she was avoiding any conversation she needed to have, a question she credited with keeping her in the cafeteria rather than in her office.

Discussion

The six themes align closely with both the research and the course framework, and they also show how servant leadership changes shape at scale. In a small team, a leader serves through direct contact; in a system of 14,000, Carver serves mostly through structures, written answers, succession lists, story rituals and fair processes, that carry her intentions to people she will never meet. Carver's identity and habits correspond to the heart and habits of Lead Like Jesus; her listening, development and culture-building to the hands; and her hard decision to a head that held a clear picture of the system's mission. Her practice also illustrates the research's mechanisms: trust, fair process, need satisfaction and serving culture appear not as abstractions but as daily habits. Most distinctive is the fifth theme. Peterson et al. (2012) found that servant leadership at the top related to firm performance; Carver's account suggests that part of that relationship may come from leaders who are trusted to make hard choices because they have served consistently beforehand.

Biblical Integration

Jesus told his disciples that the rulers of the nations lord it over their subjects, but that among them the great must serve (English Standard Version Bible, 2001/2016, Mark 10:42-43). Carver's authority over thousands did not exempt her from that rule; it multiplied the number of people she was responsible to serve. Her willingness to stay in the cafeteria with the people her decision had harmed recalls the shepherd who does not flee when the flock is threatened (John 10:11-13). And her habits reflect the pattern of Jesus himself, who withdrew to pray before the demands of each day. Her story also illustrates the sixth criterion our group identified in Week 4, the courage to correct and decide. Service, in Carver's practice and in Scripture, is not the avoidance of hard things but the willingness to bear them alongside the people affected, as Paul described carrying one another's burdens as the way to fulfill the law of Christ (Galatians 6:2).

Implications for Leaders

Three implications follow for leaders of large organizations. First, servant leadership must be built into routines, because a leader's personal presence cannot reach everyone. Second, painful choices put servant leadership to the proof instead of suspending it; the research would benefit from studying them more directly, as Eva et al. (2019) suggest. Third, leaders need habits and relationships that sustain them, because serving thousands of people through painful choices is draining. These implications apply well beyond health care, to any organization large enough that its leaders cannot know everyone they serve.

Limitations

This study rests on a single interview, and leaders describing themselves may present their best side. A fuller study would include interviews with the leader's direct reports and employees affected by her decisions, and data on outcomes such as turnover and engagement. The themes are offered as illustrations of the research, not as evidence for it.

Conclusion

The interview suggests that servant leadership can operate at scale when leaders root their identity in something deeper than their position, make listening visible, develop successors, shape culture through stories and habits, and carry hard decisions personally. The research explains why these practices build trust, voice and service; the interview shows that they include the courage to decide and the humility to stay. For students preparing to lead, the lesson is practical: the habits that make servant leadership possible in a crisis, listening, developing others, telling stories of service and renewing one's own heart, have to be built long before the crisis arrives.

References

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Blanchard, K., Hodges, P., & Hendry, P. (2016). Lead like Jesus revisited: Lessons from the greatest leadership role model of all time. W Publishing Group.

Chiniara, M., & Bentein, K. (2016). Linking servant leadership to individual performance: Differentiating the mediating role of autonomy, competence and relatedness need satisfaction. The Leadership Quarterly, 27(1), 124-141. https://doi.org/10.1016/j.leaqua.2015.08.004

Collins, J. (2001). Good to great: Why some companies make the leap... and others don't. HarperBusiness.

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English Standard Version Bible. (2016). Crossway. (Original work published 2001)

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