Arkansas Hospitals Health & Science

Servant Leadership and Health Care: Critical Partners in Changing Times

In a rapidly changing global environment, health care is in the eye of the storm. Forces threaten from all sides. There’s the ever-present uncertainty surrounding health care legislation combined with today’s heightened expectations of patients, families and consumer groups. Add to that the pressure of staying on top of all technological advancements – both on the clinical side and the IT side – and the dilemmas we all face involving staff and resource challenges: attracting and engaging employees and providers while balancing the need for more programming and better resourcing strategies.

Yet at the heart of all the chaos and complexity lies the mission of health care: to provide quality, accessible, ethical, economical and patient-centered service. Despite the whirlwind around us, that is the mission to which we must remain true.

Healthy organizations are places where employees want to work and patients want to receive care. But healthy organizations, like healthy individuals, don’t just happen – it takes work. Healthy work environments demonstrate “organizational ecology”: the equilibrium between handling immediate tasks and concerns and building systems that strengthen the organization over time.

Healthy organizations are agile in managing incremental change and astonishing in leading transformational change. Often their blueprint for success includes a leadership/cultural model that is obsessed with service and maximizes the contributions of all personnel. That kind of foundation serves the employee, serves the patient and serves the organization. This is the essence of servant leadership.

Servant leadership appeals to C-suite executives, physicians and nursing leaders with enterprise-wide impact who seek to transform the workplace. Mid-/first-level managers and supervisors use servant leader principles to create high-performing teams, improve the work environment, and develop themselves for greater responsibility. Importantly, it is also of value to front-line employees, offering them the opportunity to “lead in place”; it allows them to be part of the change they want to see, wherever they happen to be in the hierarchy. Servant leadership allows employees at all levels to be co-creators of the organization.


Based on the work of Robert K. Greenleaf, servant leadership is not about a single style of leading – it is a philosophy and set of practices that overarches all styles of leading. It influences how we hire and fire, plan and hold accountable, think and behave, relate and communicate.1
As a business executive and educator, Greenleaf conceptualized the servant leader as a person of integrity who leads an organization to success by putting the needs of customers, employees and communities first, by sharing knowledge and power, and by helping people perform at their highest capacity.

Greenleaf defined the servant leader as a servant first, who then makes a conscious choice to lead. That person is sharply different from one who is a leader first, with the perks and power this status implies. The difference is both a matter of motivation and methods and, Greenleaf maintained, manifests itself in the care taken to make sure that other people’s highest priority needs are being served.

How is a servant leader recognized? Greenleaf formulated his Best Test: Do those who are served grow as individuals? Do they become wiser, freer, more autonomous, and more likely themselves to become servants? And what is the effect on the least privileged of society: will they benefit or at least not be further deprived?2

All the traditional management skills and competencies are required of servant leaders, but what distinguishes them from the pack is:

  • Authentic humility: a regular practice of reflection;
  • A focus on serving followers for their own good, not just the good of the organization, thereby instilling a sense of collective ownership in the organization’s success;
  • Concern for the well-being of all stakeholders – patients, families, staff, suppliers, contractors and the community as a whole;
  • Emphasis on providing opportunities for growth and professional development;
  • Coaching and creating more servant leaders; and
  • Leading by moral authority instead of relying on positional authority alone: inspiring “followership.”


Health care and servant leadership are natural – even critical – partners in times of change and uncertainty. Despite the noblest of missions and the highest of intentions, health care institutions cannot meet the challenges of the day without a foundation that both supports them and permits them to shine. It’s not good enough to think about customer service from time to time, or to pay attention to staff only when the annual employee satisfaction survey is due. It doesn’t work when we focus on the tasks at hand without attending to the organizational characteristics that shape how we fulfill those tasks.

The health care leader’s eyes must be on many things at once: quality improvement, budget, diversity and inclusion, systems thinking, civility, ethics, psychological safety, succession planning, etc. Servant leadership helps us to connect the dots – to create a climate that produces results and build a culture where service is the guiding principle.

The literature has linked servant leadership to a broad array of positive business outcomes and organizational citizenship behaviors such as: collaboration and effectiveness, service orientation, satisfaction with the supervisor, innovation, individual and team effectiveness, employee engagement and return on investment.

Servant leadership forges a patient-centric, customer-conscious mindset; develops employees in place and prepares the next generation of leaders; encourages “big picture” thinking and foresight; generates an attitude of mutual respect and accountability; and enhances the
bottom line.

Servant leader organizations are “webs of connection,” giving the leader an advantage in:

  • Understanding situations in their larger context;
  • Preventing unanticipated consequences and mitigating crisis;
  • Foreseeing impact/exercising foresight;
  • Maximizing resources and epitomizing results; and
  • Serving colleagues and clients with reverence.


As a CEO in a major health care system, I often asked managers, “Would you describe yourself as a good corporate leader or as a good servant leader?” That always stimulated spirited discussion on both sides of the question. And I was always gratified when someone would respond, “What’s the difference?” The obvious answer is that there should be no difference.

The truth is, there are organizations that bill themselves as servant leader institutions and are anything but. There are too many corners of health care where command and control management still exists.

Culture is the personality of an organization. It is pervasive. It is the way things are really done. Culture is reflected in decisions, actions, and attitudes throughout the organization, and leaders are responsible for creating the culture. What behaviors do you reward? Do your metrics measure evidence of serving and caring, patience and growth, humility and team accomplishment?

Servant leadership is countercultural because it validates leaders who are inclusive, generously offering seats at the decision-making table. It is countercultural in listening, sharing credit, addressing others’ highest priority needs, upending the hierarchy – in being servant-first.

In hierarchical organizations, the optic of power is the pyramid; power is top-down. While hierarchy is in itself a neutral system, the potential for misuse is inherent. Servant leadership inverts the pyramid; it upends the hierarchy, so that the ones being served are at the apex of the pyramid and the ones serving are at the base.

Servant leaders do not relinquish responsibility, but they allocate power broadly. Servant leadership is about understanding the human impact and corporate consequences of one’s actions and decisions, and leaving the organization in a better state.

Servant leadership is countercultural in the best sense. Given the cultural shortcomings of traditional heath care, a counterculture of servant leadership would do well to become the “new normal.”


Servant leadership is not for the fainthearted! It is not soft, laissez-faire, lenient or anemic leadership: it requires strength of self-mastery, strength of action and strength of relationships. Servant leaders operate from courage, persistence, resilience, accountability and a steady internal compass.

Whether your health care system is welcoming to the servant leader model or skeptical of it – if those around and above you support the idea, or you are feeling like a voice in the wilderness, take the first step. Don’t wait for the memo! Servant leadership is a journey with fits and starts, failures and successes. Most servant organizations, and servant leaders, are works in progress.

There is no “formula” for this journey, but our experience has suggested steps that can move an organization systematically in the right direction:

  • Generate interest; raise awareness. Talk about servant leadership. Identify examples of it in everyday practice. Touch on it in meetings and town halls. Schedule servant leadership events. Include it in newsletters and written materials. Get everyone involved.
  • Educate both current and developing leaders in servant leader principles. Teach all employees about their role in a servant organization and help them discern their personal contribution to a mission of service. Everyone in the organization is a caregiver; everyone can be a servant leader in their niche of service.
  • Leaders are the primary models and messengers of servant leader behavior, which is then replicated throughout the organization. Language must consistently reflect the principles. Review policies, budgets, position statements, employee memos, performance appraisals, patient correspondence, public reports, marketing materials, etc. through the lens of servant leadership.
  • Provide self-assessment opportunities. As one example, the Veterans Health Administration developed an online 360-degree instrument3 based on the Seven Pillars of Servant Leadership4 to help leaders assess their servant leader competencies and plan for growth.
  • Measure organizational outcomes, but allow time for culture change to take root. Consider creating a servant leader index/balanced scorecard that cross-references supervisory outcomes, workgroup effectiveness, and external quality metrics. Include questions in employee satisfaction surveys that gauge servant leader behaviors.
  • Integrate servant leadership into other corporate priorities to avoid a “flavor of the month,” and to survive leadership turnover. Build it into human resource processes, performance objectives, information and communication systems and customer service programs. Weave it into the fabric of the organization.
  • Sustain the effort over time. Without a plan to support and grow the culture, it will succumb to entropy or attrition. Be intentional about maintaining it. What you are seeking is more than individual servant leaders – it is a servant organization.


Leadership is a personal decision to serve. Servant leadership does not replace traditional management functions, but shapes how they are performed. Servant leadership doesn’t always make things easy or comfortable. It often challenges us to think and act differently. Servant leaders will make mistakes, but they are less likely to be derailed by unethical or unaccountable behaviors.

It is surprising that servant leadership is not the predominant model in all health care organizations. It seems such a natural and vital partnership. Both have caring and serving at their core. But in a perpetual state of crisis and change, the business part of health care and the mission part of health care sometimes fail to intersect.

There is a business case, a human resource case and a customer service case to be made for servant leadership. While preparing us for the hard realities of health care management, servant leadership achieves success by affirming the very values and relationships that make health care a calling. It is good to remember that service is not a by-product of leadership: it is the whole point.

Now retired, Linda W. Belton was a senior executive in the U.S. Veterans Health Administration and directed Wisconsin’s VA hospital system and private sector facilities. She served on the Board of Trustees of the Greenleaf Center for Servant Leadership. A Fellow in the American College of Healthcare Executives, she is the author of A Nobler Side of Leadership: The Art of Humanagement (2016).

Phillip Anderson serves as the Co-Program Director for the Greenleaf Center for Servant Leadership. He develops and presents training material, teaches classes and workshops, assists with events, and helps cultivate the servant leadership community. He also owns ReThink! Consulting Group and teaches at IUPUI (Indiana University-Purdue University at Indianapolis). You may reach him at

The above article is from Arkansas Hospitals, a custom publication of Vowell, Inc., which also produces Arkansas Money & Politics.

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