The Effects of Cultural Aspects and Leadership Practices on The

IBIMA Publishing The Journal of Organizational Management Studies https://ibimapublishing.com/articles/JOMS/2020/790792/ Vol. 2020 (2020), Article ID 790792, 18 pages, ISSN: 2166-0816 DOI: 10.5171/2020.790792

Research Article The Effects of Cultural Aspects and Leadership Practices on the Healthcare Organizations’ Performance: The Case of Saudi Arabia Namshan A Algarni 1, McLaughlin Patrick 2, Nouf M Alqarni 3 and Majed Mutlag Alotaibi 4

1King Saud university – College of Business Administration, Saudi Arabia

1,4 King Khalid Military Academy- National Guard

2,3 Cranfield university, Cranfield, United Kingdom

Correspondence should be adressed to: Namshan A Algarni; [email protected]

Received date: 26 June 2018; Accepted date:7 September 2018; Published date: 17 December 2020

Academic Editor: Susan Chin

Abstract This article aims to investigate the effects of cultural factors and leadership practices towards organisational performance development in healthcare organizations. A case study of one of Saudi Arabia’s key healthcare providers was used. This study investigated the leadership practices, organizational culture, and performance improvement in the case study of healthcare organisations using qualitative interpretive paradigm to explore, explain and describe “the current state” based on the perceptions and opinion of individuals. Constructive-interpretivism philosophical approach is used for this study, employing a qualitative strategy. The study is specifically sought to determine the factors that promote and inhibit leadership performance improvement culture. Results suggest the heavy influences of organisational culture and other factors in the case study sector such as religious and national cultures, on the leadership performance. Research participants indicate that positive and negative behaviours of leaders and executives in top management affect the performance of employees and shape the organisational culture. The implications of these findings are highlighted, as well as the need to further explore how cultural factors and leadership practices can affect the level of productivity in this vital sector.

Keywords: healthcare performance, Saudi Arabia, leadership practices, culture, management practices, communication

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Cite this Article as: Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020)," The Effects of Cultural Aspects and Leadership Practices on the Healthcare Organizations’ Performance: The Case of Saudi Arabia”, The Journal of Organizational Management Studies, Vol. 2020 (2020), Article ID 790792, DOI: 10.5171/2020.790792

The Journal of Organizational Management Studies 2 ______

Introduction Bass and Riggio (2006) and visionary leadership (Sashkin, 1988) theories have Recently, a number of studies have examined inspired volumes of research and numerous the effects of leadership practices and training programs for business managers organizational culture on the productivity of (Thach and Thompson, 2007). healthcare organisations (Holden et al. , 2015). According to McDonald (2014, p. 227), “There However, reviewing related literature is a trend in healthcare systems around the showed a lack of understanding and research world to place great emphasis and faith in on the impact of leadership and culture on the improving leadership”. Furthermore, productivity of organisations in Saudi Arabia leadership development is increasingly particularly (Aseri, 2015; Khan and Varshney, recognised as fundamental to efficient and 2013). Precisely, the limitation of social high-quality healthcare (King, Commission on research towards organizational and Leadership and in the NHS, 2011),(A. West et structural reforms in the services of the al. , 2014a). Also, leadership development is a healthcare sector has also been alluded by Al- key strategy for building cultures that value Borie and Abdullah (2013). Thus, the experiences of patients and staff, learning emphasising a need to investigate and and safety, (Francis report, 2013), quality understand the impact of leadership practices (King, Commission on Leadership and in the and organisational culture on the productivity NHS, 2011), (Berwick et al., 2008), of healthcare sector organisations. effectiveness and knowledge translation (Kitson et al. , 2008). Cultures that provide There is little empirical evidence of the high-quality care are characterised by shared contribution of leadership practices in values translated into agreed ways of working shaping the effectiveness of healthcare in the that embrace care, compassion and support. Gulf Cooperation Council (GCC) countries and Such cultures are developed through a particularly in the KSA (Khoja et al. , 2017). leadership that recognises collective The GCC consists of six member states; endeavours rather than command and control Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, (A. West et al. , 2014b; Washington et al. , and United Arab Emirates (UAE). These 2016). Organizational culture and leadership countries are currently experiencing an can be seen as two sides of the same coin, to increased demand for healthcare services due the extent that leadership affects culture as to immense population growth, increasing life much as culture influences leadership expectancy (Al-Bosaily et al. 2017). (Schein, 2010). The role of Islam as the first tenet of Saudi Earlier studies show a strong and consistent culture is largely established based on the association amongst workplace Qur'an (the holy book) and the Sunna (the characteristics that facilitate improvement. sayings and practices of the prophet For example, Fottler (1981) discusses how Mohammed, peace be upon him) (Tønnessen, the different constraints that characterise 2016, Aldraehim et al. , 2012). These two different sectors are likely to affect the sources unify the Islamic world and Saudis performance of managerial functions through Sharia law, which affects both the (planning, organising, leading, and morality and the practice of employees in the controlling). Studies have also identified some workplace. healthcare leadership characteristics that can However, leadership is a major area of inspire enthusiasm in others to include; a interest within the field of healthcare positive vision, inspiring core values, performance development Almgren (2017), emotional intelligence, courage, and an Armit et al., (2015), and delivering engaging and inclusive leadership style improvements in the quality and safety of (Bilimoria et al. , 2005). In particular, healthcare remains an international challenge charismatic House (1996), transformational (Turner, 2017; Taylor et al. , 2014). ______

Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020), The Journal of Organizational Management Studies, DOI: 10.5171/2020.790792

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Significantly, the Kingdom’s SR 270 billion understanding of the culture improvement in healthcare plan under Vision 2030 will set the field study. Schein’s view focuses on what Saudi Arabia on a fast trajectory to growth in artefacts and values reveal about underlying the sector, projected to be a SR 92.6 billion assumptions (Schein, 2010). Schein argues market by 2020 (Saudi Embassy in the USA, that culture is a perceptual structure of 2017). Hence, the Saudi Vision 2030 presents underlying assumptions that have been certain challenges to the healthcare sector in discovered, developed, or improved by a terms of achieving Saudization targets and given group as it learns to cope with its reducing dependence on foreign workers (Al- challenges of external adaptation and internal Bosaily et al. , 2017). Expatriates currently integration (Schein, 2016). make up much of the professional workforce, such as doctors, but Saudi Vision 2030 Understanding the philosophical position requires increased employment of Saudi underlying the research is critical to choosing nationals in these positions. This shows that the most appropriate research design for education standards in the Kingdom, research projects (Broad, 2014; Collins, including those for medical and nursing 2017). However, this study investigates the degrees, will need to be raised to facilitate the aspects of the use case environment and achievement of that vision (Saleh and Otaibi, explores how the use case environment’s 2017). culture ultimately affects the performance of its top-ranking officers. Top management This exploratory study was an initial stage of teams create organizational culture based on a research project designed to develop a their histories and personalities (Schein, framework to facilitate a culture of leadership 2010), this explains why research has performance improvement in the healthcare extensively addressed the impact of founders sector. An initial objective of the project was or leaders on organizational culture (Klein et to understand the current situation by al., 2013; Nguyen and Mohamed, 2011; Sarros identifying the aspects that promote and et al., 2002; Schein, 2010). those that inhibit leadership performance improvement culture in the healthcare sector An exploratory study was designed to in Saudi Arabia. This is in line with Weber and determine the effects of leadership style and Joshi (2000) who indicate that cultural practices on the job performance of leaders in assessment functions can help the leaders of Saudi Arabia’s healthcare sector. Hence, this healthcare organisations to facilitate the study used a constructive-interpretive desired change. According to Weber and Joshi philosophical approach, applying a qualitative (2000), this can be achieved by answering strategy to answer its questions and achieve three crucial questions; first, what is the the objectives of the research. Qualitative current culture? Secondly, what is the desired analysis was employed in this study to gain culture? and thirdly, what gaps exist and how insights into the aspects that dominate the can they be bridged? This study aims to field study (use case domain) practices, as this address these questions by investigating the could help identify and characterise the real factors/aspects that promote and those that situation of phenomena. According to Yin inhibit the improvement culture of leadership (2013, p .14), “a distinctive need for case performance in the healthcare sector of Saudi study research arises out of the desire to Arabia. Our study therefore provides insights understand complex social phenomena”. into how cultural aspects and leadership According to O’Leary (2017), qualitative data practices affect management performance in are represented through words, pictures or the healthcare sector. icons and analysed using thematic exploration; quantitative data are Methodology represented through numbers and analysed Schein’s model of organisational culture was using statistics. Given that the present employed in this study to gain an research into social phenomena is

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Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020), The Journal of Organizational Management Studies, DOI: 10.5171/2020.790792 The Journal of Organizational Management Studies 4 ______

exploratory and interpretative in nature, Before the fieldwork began, ethical clearance qualitative methods are, as stated above, the was obtained from Cranfield University. Data most appropriate for it (O’Leary, 2017; were collected over several months between Denzin and Lincoln, 2017; Alvesson and June 2015 to February 2017. Other qualitative Sköldberg, 2017). To gain a sufficient methods, such as a focus group and understanding of the participants’ thinking observations, were considered essential in and their views about leadership, qualitative this task to improve the validity of findings. research is often effective and efficient (Lincoln and Denzin, 1994; Bryman and Bell, By following guidelines from Binder and 2015). Furthermore, Cassell and Symon Edwards (2010, p. 241), research participants (1994), Alvesson and Sköldberg (2017), also were continually recruited and interviewed suggest that the qualitative method is until the point at which no new data were particularly useful if the research question is produced that added new information or related to organisational processes. This insights for constructing the theory. Figure 1 study has utilised interviews, informal chats, below illustrates graphically the overall data field notes, journals/magazines, observations collection process of the study. However, to collect the required data. According to throughout the iterative steps in data Padgett and Deborah (2016), in qualitative collection, theoretical sampling was followed research, the potential data come from to determine a certain level of saturation, as different sources, such as formal and informal shown in Figure 1. interviews, participant observation and document analysis.

Figure 1: Data collection process

An issue focus (Sackmann, 1991) enables the knowledge (McLaughlin et al., 2005). This surfacing of the hidden components of method helped the research to identify and culture. Furthermore, an issue-focus method understand the aspects that influence the introduces a specific context that forces culture of the organisation. participants to draw on their existing ______

Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020), The Journal of Organizational Management Studies, DOI: 10.5171/2020.790792

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This research took place in one of the largest This includes covering the related concepts, governmental healthcare providers in the definitions, models and frameworks. KSA. Health affairs of the Ministry of the Saudi National Guard were involved as samples of Methods this study. To make each interviewee feel as comfortable as possible, the interviewer Conduct a literature review of articles and maintained good interactions and documents. Attend conferences; meet and relationship with participants prior to each discuss the topic with experts and colleagues. interview. The interviews with the research This phase is to identify key aspects, main participants generated 23 hours of audio authors and writers, as well as specialised recording and 624 pages of transcription for journals and organisations. analysis. Theoretical saturation was reached after 33 interviews, the interviews were Phase Two: Carrying Out Pilot Studies transcribed and translated into English and Tasks then analysed. The data management and analysis tool selected was NVivo software. To determine in detail the main research This qualitative data analysis package was problem in the field study that will be used for coding and to facilitate the analytical investigated in this research. Also, explore the processes. existing enablers and inhibitors that influence leadership performance in the healthcare The data of this study were collected and then sector of the KSA and its characteristics. First, triangulated – semi-structured interviews the researchers conducted a pilot study were checked against the findings from a between June and July 2015. focus group discussion and direct observation. Methods

According to Golafshani (2003, p. 604), “To The researcher designed and conducted a improve the analysis and understanding of pilot study in the KSA as an initial step in construction by others, triangulation is a step order to help in clarifying the research taken by researchers to involve several problem issues and key elements. This study interpretations of the data by several used interviews (issue focus) with selected investigators or peer researchers at different interviewees among the health affairs of the times or locations”. In addition to that, Ministry of Saudi National Guard. triangulation is needed to ensure trustworthiness of a study and to identify The fieldwork of the first stage of the study potential alternate explanations (Lincoln and consisted of nine semi-structured interviews Guba, 1989). with participants from different job/position levels to elicit their beliefs and experiences. To achieve the aim and objectives of this The questions aimed to identify the factors research, the following phases have been that relate to performance level, as identified. encouragers or inhibitors of performance improvement. Phase One: Exploring the Literature Review Before the fieldwork began, ethical clearance was obtained from Cranfield University. The Tasks face-to-face interviews of the pilot study each Conduct a comprehensive review of the lasted between 45 and 92 minutes. In an literature in order to understand the various attempt to make each interviewee feel as aspects of the research and to establish a comfortable as possible, the interviewer tried comprehensive understanding of the field of to build a good relationship with participants research topic, as well as other related areas. prior to each interview.

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At the start of data collection, the participants received a description of the purpose of the After the first phase of interviews had study. All of the participants agreed to the finished, the researcher began to analyse the audiotaping and transcription of the data to discern the main themes, phenomena interviews, which produced a total of 515 and problems in the field in order to focus minutes of speech and over 187 pages of upon, explore and better understand them in transcripts. The interviews were first the succeeding phases. After transcribing the conducted in Arabic, and then the interviews recorded interviews and collecting the were transcribed and translated into English. relevant documents, the researcher re-read The study aimed to investigate what aspects the data several times to ensure an in-depth in particular of the field under study and its understanding of the case study. Following culture ultimately affect the performance of this, coded them and compared them with its top-ranking officers. The data were each other (theoretical sampling). These collected and then triangulated – semi- codes/concepts were then categorised and structured interviews were checked against a the categories, in turn, were compared and document review and the findings from a verified. The data were read again to enrich focus group discussion and direct and/or confirm the categories. observation. Constant comparisons with the literature and Jick (1979) explains the term ‘triangulation’ the collected data were carried on. The as the use of multiple techniques for data iterative steps of data collection from the collection and analysis to investigate the same participants was performed. During the phenomenon from different viewpoints. second stage of the study, the second series of Verbatim quotations representative of the personal interviews were held between data were selected (McAlearney, 2006). December 2015 and January 2016. The However, the researcher allowed the data to interviewees were asked to take part in tell their own story, not spinning them to refining the aspects that emerged in the initial cover any specific topic. The researcher stage of the study. immediately wrote notes about every interview as soon as it ended.

Figure 2: Participants demographic Findings of the KSA, and play crucial roles in inhibiting or encouraging the development of leadership The results of this study revealed 71 aspects performance in this sector. Table 2 below that promote and inhibit the performance displays the aspects that were obtained from improvement of leadership culture. These the analysis and description of the data. It also results show the aspects that influence the illustrates the number of appearances of each behaviour of leaders in the healthcare sector aspect. ______

Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020), The Journal of Organizational Management Studies, DOI: 10.5171/2020.790792

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Table 1: Aspects with its frequencies and descriptions

No. Number of Aspect Description frequencies A short probationary period for evaluating 1. An assessment period for and discerning the proficiency of candidates 7 employing a new candidate before confirming their employment positions. 2. Avoiding selective employee preferences Avoiding favouritism/ based on ethnic, racial, or religious 15 tribalism affiliations, which can cause cooperation to break down. 3. Acknowledging and according value to Appreciation 21 employee attributes and/or outputs. 4. Placing stressful requirements on employees Applying pressure 17 in a second attempt to solve problems can sometimes bring about good results. 5. Performance declines and stalled organisational improvement due to the 12 Blocks to development extended absence of developmental initiatives. 6. Consolidating process and decision control Centralisation 12 under one central influence or authority. 7. Extending demanding tasks to employees, typically beyond their known capacities, with Challenge 4 a view to unveiling or discovering inherent, hidden, unused skills and potentials to bring about positive change. 8. Undertaking rigorously attentive Close supervision 10 management oversight on the performance or operation of employees or situations. 9. Joint work by leaders and employees for Collaboration 10 unified organisational goal(s). 10. Perceived concurrent application of both Combining a human aspect 11 social (human) and rules-based approaches with regulation for better employee output. 11. Organisations should have well-defined

Communication channels for conveying and exchanging 21 information at all levels among employees. 12. Complaints within organisations are inherent and critical and should be speedily Complaints 8 followed up upon in every work environment. 13. Leaders should be quick to bring peaceful solutions to disagreeing parties and interests

within the workplace in the interest of Conflict resolution 8 continuity and performance of the organisation 14. Timely response to employee inaccuracies to

Confronting mistakes forestall possible deviations from the 17 targeted organisational goals.

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No. Number of Aspect Description frequencies 15. Continuous and ceaseless monitoring by Constant observation workplace leaders to drive productivity and 13 performance improvement. 16. A successful organisation keen to target goals should create a suitable work environment Creating an appropriate for employees that will drive work working environment 113 perception, motivation and inputs to targeted goals. 17. Basing leadership on teamwork and Creating work teams that encouraging cooperation and team spirit work cooperatively 15 among employees. 18. Boosting employee commitment, loyalty and

Empowerment and delegation confidence by delegating leadership and 15 authority. 19. Continually updating and improving upon

existing knowledge in all aspects, to sustain Enhancing knowledge 10 relevance, headship and firmness. 20. Subscribing to and undertaking external,

External training courses standard and globally accepted professional 5 training courses. 21. Improving performance through creating interactive platforms and facilitating the Exchanging experiences 9 exchange of know-how between leaders and employees in the organisation. 22. Ascertaining employees’ willingness to work,

or desire for self-development through the Evaluating the employee 4 continual delegation of tasks and observance mind-set of reactions. 23. Ensuring impartial, or non-selective management of employees, but rather Fairness and equality 37 conforming to laid down organisational rules and policies. 24. Giving a more flexible working structure through the institution of structured breaks Flexibility and breaks 15 and time-out periods for employees after extended periods of work.

25. Improving performance through building Human interpersonal good human interpersonal relationships relationships 19 among employees for a more friendly and motivated workplace. 26. The quality of being modest in interactions

Humility with other employees. An attitude that 14 leaders desire from employees. 27. Improving employee capacity through Improving capacity 17 training and education for knowledge and skills. 28. Being able to tie motivating factors to the Individualising employee individual, as different people can have quite motivations 12 different motivators, e.g., money, recognition, time off, promotions, etc.

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Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020), The Journal of Organizational Management Studies, DOI: 10.5171/2020.790792

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No. Number of Aspect Description frequencies 29. Using other employees or third parties to Indirect leadership and correct employee inaccuracies in the guidance 12 organisation. 30. The use of, or support of new ideas or Innovation 13 concepts from employees. 31. Being part of the effort to solve (potential) Involvement in solutions 16 problems in the workplace. 32. Mutual relations and interfacing between Interaction between leaders leaders and their subordinates in the and employees 17 organisation. 33. The quality of being honest, upright and Integrity 17 reliable. Having strong moral principles. 34. Leadership’s personal ability to relate easily and liberally, which helps them manage their Interpersonal skills 16 work whilst building relationships with employees. 35. A decent interpersonal Interpersonal loyalty that can relationship/employee allegiance in the benefit the organisation 7 workforce that fosters organisational benefits. 36. Engaging instinctive knowledge in the discovery and constructive exploitation of Intuition 11 subtle employee capability for organisational gain. 37. Managerial skills and practice deficiencies in Lack of administrative skills leadership, amounting to incompetence in and experience 15 duty and a loss of employee confidence. 38. Lack of appropriate incentives to support Lack of incentives 6 and motivate employees to boost outputs. 39. Good leadership gains respect and admiration by exemplifying and portraying

what is expected of employees in all aspects Leadership by example 15 emphasising commitment to the organisation in order to gain their respect. 40. Boosting employee self-esteem by leadership, using supportive language and Leading by rhetoric 5 expressions to drive loyalty and improvements in performance. 41. Leaders need to engage in gradual positive changes in the work environment to build Make changes 9 and sustain employee interests and productivity. 42. Boost employee devotion, confidence and Make employee feels sense of duty through the delegation of responsible 12 responsibilities and reporting. 43. Leadership’s depiction of good character and Morals 13 behaviour when dealing with subordinates. 44. Part of the criteria for employment should Morality criteria for include the human aspect of sound moral employment 12 values, in balance with other requirements. 45. A relationship built on reciprocated trust Mutual trust 15 between leadership and employees and the

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No. Number of Aspect Description frequencies degree to which that is expressed in the workplace. 46. Reciprocated esteem or regard to a person, Mutual respect 8 or his/her views regarding needs, space, friendship, etc. 47. Specific aspects of national culture which National culture 28 potentially affect performance improvement in an organisation 48. Process of monitoring employees’ Observation with evaluation performance and basing evaluations on indicators 12 clearly defined performance indicators 49. Making the direct and unrestricted exchange of messages or information between leaders Openly communicating 22 and followers possible in an organisational structure. 50. Some employees are keen on building Personal relations with personal relations with leaders as a strategy

employees to support their to attain self-gains (promotions, external 21 personal issues training and other incentives) in the organisation. 51. Building good interpersonal relationships with and among employees is key to Personal relationship 20 improving performance and achieving a conducive working environment. 52. Preventing the kind of conflict that may arise Personifying the work between leaders and their employees as a environment 22 result of discussing mistakes related to the workplace. 53. Rewarding hard work and excellence in deserving employees to motivate and Rewards 8 persuade others in the organisation, e.g. awards for employee of the month/year. 54. Being receptive and supportive to new and

Responsiveness to change positive employee ideas for changes and 10 improvements. 55. Granting acknowledgment and appreciation

Recognition to employees for their achievements and 8 efforts. 56. Religious values and beliefs that influence

Religious values (Islamic) leadership thoughts and employee 39 relationships in an organisation. 57. A sequence of habitual organisational procedures, and adherence of which is Routine 15 capable of hampering creativity in the workplace. 58. Establishing well-defined policies and criteria for employee evaluation, appraisal, Setting fair evaluation criteria 13 benefits and promotion and unconditionally ensuring strict adherence. 59. Having a clear consciousness and Self-awareness 8 understanding of self; thought pattern, ______

Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020), The Journal of Organizational Management Studies, DOI: 10.5171/2020.790792

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No. Number of Aspect Description frequencies behaviour, and responsiveness to others. This self-ability helps better structuring of personal and professional relationships. 60. Leadership style that supports mutual

Sharing in decision making contributions to decision making by both 8 leaders and employees in an organisation. 61. Making leadership decisions that depend on Situational approach decisions 16 the situation and personal dispositions. 62. Keenness on earning achievements promptly Speed and punctuality 12 through driving punctuality from employees 63. Adopting a structured approach to thinking, assessment, organisation and the Strategic thinking 8 establishment of capacities, goals and policy requirements 64. A formal approved duty of a designated department in the organisation, which Supervising the relationship involves observing, assessing and managing between managers and the relationship between these two sides to employees in the workplace 18 avoid relational frictions capable of affecting normal work. 65. Leadership and organisational support and encouragement for employee creative Supporting initiatives 12 suggestions and propositions for work improvements. 66. Broad-mindedness towards employees’ mistakes, misbehaviours and criticisms, Tolerance 22 allowing for gradual learning and improvements. 67. Setting up courses and activities for employees to build their knowledge, skills Training 18 and competence for undertaking organisational roles and responsibilities. 68. Understanding the organisation’s mission, or Understanding the vision and its purpose for existence. A mission often mission of an organisation 10 reflects the values and beliefs of top managers in the organisation. 69. Underrating and failing to appreciate the Undervaluing employees' importance of employees in an organisation status 18 is likely to yield negative performance and outputs 70. Leadership is expected to apply varied skills for dealing with varied employee Using different skills in personalities, behaviours and situations in different situations 12 relation to organisational objectives and requirements. 71. Unclear articulation of tasks, duties, targets Unclear tasks and information 3 and timelines by leaders to their employees.

The results of this exploratory study found sector in Saudi Arabia as illustrated above in that different factors influence the level of Table 1. Particularly, culture-related factors leadership performance in the healthcare seem to play a key role. The study also finds

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the heavy influence of organisational culture combination of human-factor and regulation, and structure on leadership performance. The use of fair evaluation criteria, difficulties dominance of these factors seems to be what introduced by the national culture, open mostly impact the decisions made by leaders. communications, personal relationships, This also shapes the relationships between personalising the work environment, and leaders and subordinates, and their tolerance. These factors yielded varied commitment to the organisation. frequencies between 21 and 37. The observed factors that mostly affect Significantly, this study finds ‘Islamic values’ leadership performance in the Saudi with a high frequency of 39 as the most healthcare sector incline towards the influencing factor in the performance of behavioural, cognitive or interpersonal leaders and employees in the organisations qualities of the leaders. Other attributes surveyed, as shown in Table 1. In this regard, emerged as important in shaping leadership one interviewee remarked, performance developments, these include; fairness and equality, Islamic values, and the “A lot of things [happen] in the work national culture. All these factors play a key environment. If we apply the teachings of Islam role in a leader’s abilities to inhibit or in our work, we will find ourselves the greatest encourage performance improvements. nation on earth, but sadly, we don't. If you think of it right, Islam says: "Allah will be pleased Another interesting finding was the variation with those who do their work perfectly". in the outcomes of assessment between male and female participants relative to the factors The second most influencing factor that identified. Presumably, the difference may appeared in these data was ‘fairness and reflect the influence of culture and religion in equality’ , with a frequency of 37. A notion of the position of females in the KSA as this perception as remarked by one presented by the study findings. For example, interviewee goes thus: study results illustrate that a few women are “For me, the features of leadership are allocated leadership positions in fieldwork- fairness and equality...along with brotherly related areas. To support this finding one of treatment. Such things—I believe—are the participants remarked, essential for leadership”. He added, “Of course “Particularly for the female here, if you the most significant thing I wish all leaders achieved a leadership position and start to would have is … fairness. [It] is very manage both genders (male and female), important…it is the basis of judgment, once it is people around you will not be confident in your applied and handled in the best way between leadership as a female, this, as you know in leaders and their followers…I find this crucial general, is a result of the national culture point to be essential with a very positive effect aspects here”. on the leader’s role, work, and responsibilities”. Surprisingly, only a minority of respondents Putting it in another way, one of the mentioned factors such as strategic thinking participants mentioned that: and shared decision-making are valuable “the major inhibitor is the lack of within a workplace environment, as shown in justice”. Table 1. Neglecting these important factors may lead to failure of healthcare Study findings also suggest a high influence of organisations’ plans to change or improve ‘national culture’ on; the practices of leaders, their services. the job satisfaction of employees, and the general commitment towards an However, most respondents agreed that other organisational goal. This factor had a factors also play key roles in leadership frequency of 28, as shown in Table 1. performance level. These include; a ______

Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020), The Journal of Organizational Management Studies, DOI: 10.5171/2020.790792

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Furthermore, the study suggests a general takes place in the health sector worldwide view from participants highlighting the which is very dynamic and changeable. So, to be importance of emotional intelligence. on top of this, you have to know what has Attributes like; being human and honest, changed and what has developed and what are showing initiative, having cognitive skills and the new things that came up in this field. an eagerness to develop capacity were noted Another thing is that a leader in the health to crucially contribute to the performance of sector should be knowledgeable. Not like any…I organisations. Talking about this issue an mean knowledgeable on daily basis. Currently, interviewee remarked: we always attend conferences, attend courses because the health sector is dynamic’. “I try to make the employees feel the importance of their decisions and ideas because To facilitate the improvement and change that will make them closer. Also, I give them my process in a workplace, the results of this guidance and advice to get benefit, follow the study emphasise the important role of instruction and achieve my goals, too. It is not engaging all staff in change plans and acceptable to deal with my staff in a complete development processes. On this, an formal way like: "hello, you have to do this and interviewee remarked: this…" certainly, they will do the task, but I do not prefer it that way”. “This could help to engage all staff in any plans for change and development and thus Some participants expressed the belief that facilitate change implementation in the creating a suitable culture and work workplace, avoid resistance, and enhance environment can support daily more commitment and loyalty”. comfortable work. Supporting this view, an interviewee remarked: Another participant also added: ‘The most important thing that a “I found that when the person is manager should be occupied with is how to convinced and feels that he is part of that create a suitable work environment, for the change and that he wants it, he will be more employee to feel that his manager or director is productive and there will be success”. supporting him and not to feel that his Interestingly, one of the most noticeable manager is always a threat to him or taking findings that emerge from this study is the actions against him’. One of the participants influence of several factors affecting commented, “I totally believe that you can leadership performance in the healthcare change the culture in a department, in the sector of KSA. For example, aiding employees environment. You can put the objectives for it who have personal issues, individualising and don’t make these objectives requirements employees’ motivation, having moral criteria from the department but a nature of the for employment, using evaluation indicators department, a culture for that department to to assess employees, supervising the work in this way”. relationship between managers and From the perspective of the workforce employees in the workplace and evaluating requirements, this study emphasises the need employees’ mindsets. to give real attention to the important factors Strategic thinking, which seems to be to improve performance. These include; currently lacking, is a key driver to improved encouraging education and supporting skills performance in the Saudi healthcare system. and personal development – offering on-the- As emphasised by one interviewee: job training for employees during their regular working hours in the same work “Without a clear strategy…when I say setting. For example, one interviewee said: strategy, some understand it as just a plan! It’s a plan that includes everything. It should have ‘So, in the way you manage, you have a financial aspect, a strategic aspect...it should to be up-to-date with the development that

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include all departments, the manpower aspect. implementation in the workplace. To support All these things must be put in an achievable this result, one of the participants remarked: plan and you have to have objectives ”. “communication with the staff is the Monitoring and evaluation are also crucial in main factor. One of the international patient the process of improving performance safety goals is effective communication among development culture. Regarding this, one of employees, between the employee and the the interviewees remarked,” patient, and between the manager and employee. Communication helps to promote “I see the evaluation as a person’s problem-solving”. mirror from where he knows his weaknesses and his strengths. The second thing is that The findings of this study also suggest that an evaluation is a chance for developing the assessment period for employing a new employee. I stand with the management that candidate can enable organizations in this says: I have that employee who has low sector to elect the most competent staff and communication skills; as an organisation, I leaders. Talking about this, one interviewee have to provide a training course for him to pointed out that: correct this weakness. I shouldn’t just look at it as a point of weakness that he has without “leadership skills, problem solving, trying as an organisation to develop the control and communication skills are essential employee” . things to follow when choosing the manager. Also, three-month experimental period is The study has also revealed one of the useful. It may be an evaluation after the challenges in the Saudi healthcare system as experimental period. This method may help to “unclear tasks and information” . This relates reduce the problems that happen because of to daily assignments from the top levels to unsuccessful leadership”. subordinates as outlined in Table 1. About this issue, an interviewee remarked, Discussion “When you give unclear guidelines to Taken together, these results suggest that an employee, that will be disappointing for there is an association between the findings of him/her. Some of them will ask you what you this study and the existing research on leader meant, whilst others may feel shy or afraid to efficiency, typically; Avolio and Gardner ask. Your responsibility, as a leader, is to (2005) and Frankel et al. , (2007). Both studies communicate clearly’’. discuss the role of organisational context and climate on leadership practices. They also Furthermore, this paper underscores the argue that a well-designed organisational importance of a clear and agreed-upon vision context can moderate the style of leadership and mission statements, which provide a behaviours. They also suggest that direction guide to staff as illustrated in Table organisations should provide open access to 1. information, resources, and equal opportunity for all employees. This in line In investigating the nature of the relationship with Smith and Vecchio (2007) who stress between leaders and their followers within that culture can determine whether or not the the workplace, most participants significantly organization is able to survive under changing believed in the importance of building a conditions. strong relationship through clear and dynamic communication channels. Hence, the However, this study produced similar findings study findings suggest a clear connection to those of Sanghi (2016) who claims that between designing flexible communication successful organisations need to adopt a channels and successful change flexible organisational structure and improve communication to implement change ______

Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020), The Journal of Organizational Management Studies, DOI: 10.5171/2020.790792

15 The Journal of Organizational Management Studies ______

effectively. Similarly, Yukl (2012) also finds position of women. Religion has also been that attention should be paid to delegating identified as a very dominant factor in seeking authority to staff and improving to preserve women’s status and confirm their communication channels between managers position as subordinate members of society. and staff. This is consistent with Franco et al. (2002) conclusion who argued that cultural characteristics can Generally, the study offers some important influence the organisational structure insights into factors that particularly affect decision-making processes within leadership performance in the healthcare organisations. Similarly, it is argued that sector of KSA. These include; maintaining cultural aspects pose a particular challenge to personal relationships with employees as a performance improvement in Saudi Arabia form of personal support, individualising (Idris, 2007; Hodges, 2017). Moreover, Al- employees’ motivations, having moral criteria Bosaily et al. (2017) indicated that healthcare for employment, using evaluation indicators organisations face challenges to promote a to observe and assess employees, supervising culture that continuously improves the the relationship between managers and quality of services, patient safety and employees in the workplace, evaluating compassion in healthcare. This result employees’ mind-set, and combining a overlaps with the thought from Sanghi (2016) human- aspects with regulations. This study is stating that organisations need to establish one of the first investigations to assess the and foster a suitable culture that can enable impact of leadership practices and culture them to build strong working relationships in factors on organisational performance of the workplace. This can be achieved through Saudis’ healthcare. However, an in-depth aspects such as working closely with the team, study on the effectiveness of these factors in ensuring that needs are considered, issues are isolation can help in addressing the issue of addressed and situations are managed in a leadership performance improvement in collaborative, consultative, creative, and healthcare organisations. flexible manner (Sanghi, 2016; Willcocks and Wibberley, 2015). References

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Namshan A Algarni, McLaughlin Patrick, Nouf M Alqarni and Majed Mutlag Alotaibi (2020), The Journal of Organizational Management Studies, DOI: 10.5171/2020.790792