IntroductIon In April 2016, Saudi Arabia launched an ambitious program, ‘Vision of 2030’, designed to address three themes; a vibrant society, an ambitious nation and a thriving economy.[1] To achieve this vision, the country announced an interim development plan called ‘the National Transformation Program (NTP) 2020’ that establishes strategic objectives for all key sectors of the economy, including healthcare. One of the vital aspects of the NTP 2020 is the introduction of healthcare sector reforms.[2] The plan emphasises the need to make efficient use of healthcare facilities and ensure that quality healthcare, including preventive services, is available to the population.[3] It also focuses on encouraging private sector investment in sectors funded previously by the government.[3]
To ensure that the objectives of the Saudi Vision 2030 are met, a team was formed to establish a change management
strategy, set plans and priorities, and then eventually implement the action desired.[3] The plan envisages that leadership in healthcare organisations will support all initiatives related to the transition plan and ensure that transformational change plans are implemented consistent with established goals. Each initiative would have its own performance indicators to ensure that the managers implement these changes smoothly.[3]
Significantly, organisational change is an important process that involves creating positive change on the part of an organisation’s followers. Most modern organisations wish to change without interruption to provide high‑quality service for customers.[4] Organisational change requires detailed planning
An Investigation of the Saudi Healthcare System’s Readiness for Change in the Light of Vision 2030: The Role of
Transformational Leadership Style Mohammad Faleh Alharbi
Department of Health Administration, College of Public Health and Health Informatics, Qassim University, Qassim, KSA
Objectives: Organisational change is among the major challenges that face healthcare organisations, and many factors affect their ability to be ready to adopt the change desired. Among these important factors are the significant role of the attitude of the leadership that is responsible for the change. This empirical study was conducted to examine the role and contribution of the transformational leadership style to the readiness for change in healthcare organisations in Saudi Arabia. Materials and Methods: Primary data were collected from a sample of 83 middle managers in the hospitals in the Al‑Qassim region in the Kingdom of Saudi Arabia. The study used a self‑administered questionnaire to examine the role of transformational leadership in the readiness for change in healthcare organisations. Cross‑sectional data were analysed using SPSS. Results: A positive and significant relation was found between transformational leadership and the readiness for change with 30% variation in the dependent variable (R2 = 0.30). Conclusions: This study is valuable for healthcare policymakers and providers, as it offers information about the leadership behaviours desired in readiness for change that have the potential to influence the intentions, attitudes and beliefs of members of healthcare organisations that help them accept and understand a change initiative.
Keywords: Health organisations, organisational change, readiness for change, Saudi healthcare system, transformational leadership
Address for correspondence: Dr. Mohammad Faleh Alharbi, Department of Health Administration, College of Public Health and Health
Informatics, Qassim University, Qassim, KSA. E‑mail: [email protected]
Original Article
Abstract
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DOI: 10.4103/jhs.JHS_142_17
How to cite this article: Alharbi MF. An investigation of the Saudi Healthcare system’s readiness for change in the light of Vision 2030: The role of transformational leadership style. J Health Spec 2018;6:45‑51.
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to ensure that it is not only positive but also is accepted by all in the organisation.[5] At the same time, organisational readiness for change serves as the vital factor in the efficient implementation of complex change in a healthcare setting.[6,7]
Many healthcare systems in developing countries and societies exhibit poor performance because of healthcare organisations’ lack of readiness to achieve the effects of change and regulate the quality and progress of the change process.[8‑10] It also has been observed that the initiatives carried out by healthcare service organisations have had only modest positive results, and their limited success is attributable to their inability to analyse successfully the workforce’s perceptions of change.[11] Further, there are various contexts of change readiness that derive from narrow or broad belief systems. In a narrow system, the potential for change is present, while a broad belief system includes appropriate leadership, social ties, resources, skills, knowledge and organisational ability, all of which are required to implement change successfully.
Various readiness components have been extracted from readiness for change models. Armenakis et al. proposed the organisational readiness for change model[12] and stated that change can be observed in the organisational workforce’s intentions, attitudes and beliefs. They also indicated the level at which the change is required and the organisation’s ability to implement this change successfully. Hence, readiness is considered a cognitive pre‑requisite for the actual behaviour to take place or the state of mind that is required to carry out the change desired. The members’ behavioural and psychological preparedness to implement change is referred to as organisational readiness. It also includes their beliefs that they can manage the change and that it is not only necessary but also advantageous. Another crucial readiness aspect is leaders who willingly are committed to the change.
The concept of readiness for change is considered to be the organisation’s holistic framework.[13] In this case, it is the members’ level of perception that the organisation can implement change as part of its large‑scale initiative. In addition, organisational members also must maintain positive perceptions with respect to the change, together with the belief that such change will lead to sustainable and positive results if it is implemented on time and successfully. This perception will benefit the organisation overall in the long run.[14‑16] On the other hand, the workforce will not be interested in carrying out the activities proposed or may sabotage them to ensure they fail if they do not believe that the change will advance the interests of the organisation, as well as theirs.[17]
The success of an organisational change on the part of different units in the healthcare system is related to the workforce’s ability to support programs and initiatives designed to develop new operational approaches that incorporate superior performance techniques and flexibility.[18,19] A reliable leadership assures that organisational cultures and readiness for change are enhanced in a healthcare entity that can develop these workforce attributes.[19‑21]
The need to understand the employment requirements and associated skills and information that diminish the likelihood of resistance to the change desired contribute to healthcare systems’ requirement to use appropriate leadership and management techniques.[22] It is always essential to formulate new and viable operational techniques that are relevant to the objectives of the organisation because healthcare improvement programs are highly important.[23,24] This is referred to typically as organisational transformation through a strategic change, and the application of appropriate organisational management techniques is necessary to regulate the activities and results of an organisation’s transformation strategy.[25] Hence, regulatory and oversight services play a significant role in ensuring that the objectives and plans healthcare organisations develop are achieved, as organisational change and transformation are intended to provide enhanced services and care to society,[26] this translates commonly as transformational leadership which essential to support the change in a healthcare organisation.[27‑30]
Brown and May defined transformational leadership as a set of managerial techniques that includes oversight through which noticeable changes occur in people at a societal level.[31] As a result, with the objective to enhance the readiness for change that results in the achievement of objectives in healthcare organisations generally, the transformational leadership style, as used in a given healthcare organisation, is designed to enhance knowledge, leadership abilities and experience in the favour of the followers.[32‑34] The approaches and procedures used to manage and regulate the behaviours and abilities of the workforce with the goal to implement the change in the organisational system desired also can be considered elements of transformational leadership. In this context, enhancing the healthcare system or organisation’s efficiency is the main agenda of transformational leadership. This can be achieved by revolutionising the organisation’s culture according to workforce performance imperatives, such as responsibility and competence in the workplace, to enhance the readiness for change.[20,34] In such cases, transformational leadership is considered vital, as it maintains the ability to enhance change‑related behaviour and promotes followers’ readiness for change.[35]
Based on the assumption that the organisational changes different healthcare organisations desire can be accomplished by the transformational leadership approach, this empirical research was conducted to investigate the role of transformational leadership approaches and skills, and the way in which they can optimise the readiness for change in the Saudi healthcare system, as there has been an insufficient investigation of this issue to date. Accordingly, the study sought to fill this gap and determine whether the transformational leadership style affects the readiness for change in healthcare systems.
The study’s findings have much significance. First, the results of the study will be significant because they will provide managers and other organisational leaders with a better understanding of the practices needed to enhance a healthcare
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organisation’s performance in the readiness for change process. Second, the information can be used as a background for strategic changes involving healthcare services operations. Third, the outcomes of the research will heighten authorities’ awareness of the changes needed in the healthcare sector. Finally, the study will contribute to the limited empirical research available by focusing on the readiness for change in the Saudi healthcare system.
Based on the argument above, the study proposed the following hypothesis:
Managers’ perceptions of the transformational leadership style are related positively to the levels of organisations’ readiness for change in healthcare organisations in Saudi Arabia.
MaterIals and Methods Research design The research used a quantitative analysis and a cross‑sectional survey design, in which a self‑administered questionnaire was used to obtain the sample respondents’ opinions.[36] The study population included all 18 hospitals in the Al‑Qassim region of the Kingdom of Saudi Arabia (KSA).[37] Moreover, in the study, middle managers were considered to be the appropriate respondents. Data were collected over 4 weeks in October 2017. This time was considered suitable, as there are not many holidays during this period and most employees were available to participate in the study. Of 180 self‑administered questionnaires distributed, 93 were completed and returned, 10 of which were invalid. Therefore, data were analysed based on responses received from 83 respondents (response rate, 52%).
Measurement of variables All items in the questionnaire were adopted from well‑known measures used in previous studies that pertained to the key variables of this research. Transformational leadership style, which consists of four components: Intellectual stimulation; idealised behaviour; inspirational motivation and individual consideration was measured with 16 items adopted from Sosik and Godshalk’s study.[38] The dependent variable of readiness for organisational change included three dimensions: emotional readiness for change; cognitive readiness for change and intentional readiness for change (IRC) that were measured through nine items adopted from Bouckenooghe et al.’s study.[39]
Data analysis The analysis was conducted with SPSS v. 21.0 (IBM Corp., Armonk, NY, USA), as it is the standard software package used to analyse data in behavioural research.
results Demographic characteristics The respondents’ demographics are presented in Table 1. The respondents were diverse with respect to age, nationality, gender, marital status, educational background and duration of current job.
Reliability test The internal consistency of the scale was evaluated with Cronbach’s alpha. According to Nunnally,[40] if the alpha coefficient is >0.70, it is considered reasonably reliable.
The reliability tests of various dimensions are summarised in Table 2 with α >0.70. The organisational change readiness and transformational leadership style measurements indicated that the Cronbach’s alpha coefficients for all dimensions were > 0.70.
Exploratory factor analysis The study carried out exploratory factor analysis (EFA) on transformational leadership style, which is comprised of the four subdimensions listed above. EFA also was conducted on the readiness for change, which included three dimensions: Emotional, cognitive and IRC.
Table 3 shows the number of items for each subdimension and presents the findings of the EFAs with respect to transformational
Table 1: Respondents’ sociodemographic variables
Variable Category Frequency (%) Nationality Saudi 81 (97.6)
Non‑Saudi 2 (2.4) Gender Male 79 (95.2)
Female 4 (4.8) Age 18‑35 41 (49.4)
36‑50 40 (48.2) 51‑65 2 (2.4) 66 and above 0
Marital status
Single 6 (7.2) Married 77 (92.8) Divorced 0 Widow/widower 0
Education background
High school 13 (15.7) College degree 48 (57.8) Master’s 10 (12) PhD 3 (3.6) Other 9 (10.8)
Duration of current job
<1 year 0 1‑5 11 (13.3) 6‑9 23 (27.7) 10 and above 49 (59)
Table 2: Reliability results
Variables Dimensions Number of items Cronbach’s alpha TFL IB 4 0.87
IS 4 0.88 IC 4 0.82 IM 4 0.91
Readiness for organisational change
IRC 3 0.84 CRC 3 0.76 ERC 3 0.80
TFL: Transformational leadership style, IB: Idealised behaviour, IS: Intellectual stimulation, IC: Individual consideration, IM: Inspirational motivation, IRC: Intentional readiness for change, CRC: Cognitive readiness for change, ERC: Emotional readiness for change
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leadership styles and readiness for organisational change. The table provides the seven subdimensions’ factor loadings for the readiness for organisational change items and the transformational leadership style items after each procedure. It is clear that there was no double loading or low factor loading (<0.50), as the items’ loading ranged from 0.55 to 0.91.
The results in Table 3 show that the Kaiser–Meyer–Olkin measure for the items was 0.76. Hence, a ‘meritorious’ adequacy can be applied in the factor analysis.[41] The Bartlett sphericity value observed was (1523.67) which was significant at P = 0.00. These results indicate that the items used were consistent with the standards for factor analysis, which allowed the EFA to be used to evaluate various items in the transformational leadership style and readiness for organisational change.
Correlation and regression analyses Correlation analysis is used to determine the direction and strength of the linear association between two variables.[42] Therefore,
the association between the transformational leadership style and the readiness for organisational change was assessed using Pearson’s correlation reported by the middle management respondents. A scatterplot review indicated that the results were distributed normally and Shapiro–Wilk’s test showed that there were no outliers (P > 0.05). Table 4 provides a summary of the correlations.
Table 4 shows that transformational leadership behaviours overall were correlated positively with readiness for organisational change, and the values of the correlation coefficient relative to the assessed relations between the variables overall were 0.56 (P < 0.01), which is considered a moderate correlation.
Linear regression analysis was conducted to test the research hypothesis and assessed specifically the degree to which each respondent’s readiness for organisational change could be explained by transformational leadership style.
It is evident from Table 5 that the transformational leadership style made a vital 30% contribution to the variance in readiness for organisational change. Further, the analysis confirmed that transformational leadership significantly predicted readiness for organisational change (F = 36.59, P < 0.00).
dIscussIon The government of Saudi Arabia has made healthcare a top priority in its development plans. Consequently, the Kingdom is implementing radical changes in the structure and function of its healthcare system to enhance the quality of care and efficacious service delivery through its NTP 2020.[1]
This research was based on theoretical and practical frameworks, and the results showed that transformational leadership style has a positive and significant effect on all components of the variable of readiness for organisational change. This finding is consistent with that of Rees and Johari,[43] who stated that in any organisation such as a hospital when the readiness for change exists on the part of the leader and his/her subordinates, the organisation is willing to accept change and therefore exhibits decreased levels of resistance. In healthcare organisations, supervisors’ transformational leadership is seen as a decisive factor that prepares the staff for change.[44] Moreover, the findings of this study were consistent with those of prior studies that have explained that when leaders have little interest in implementing change, individuals in the organisation will not have the support needed to implement that change. Further, when the heads of healthcare organisations do not have the skills or knowledge necessary for the change process, it becomes impossible to implement change efficiently.[45] Hence, effective transformational leaders have the ability to offer support that can change employees’ core beliefs and positions and help them accept and understand the motivations and goals of the change. According to Bass,[46] leaders who are able to motivate employees within the organisation and increase the awareness, interest and confidence on their part that will
Table 3: Exploratory factor analyses
Items Component
1 2 3 4 5 6 7 TFL14 0.91 TFL16 0.80 TFL15 0.80 TFL13 0.79 TFL6 0.85 TFL8 0.82 TFL5 0.82 TFL7 0.61 TFL2 0.84 TFL1 0.77 TFL3 0.75 TFL4 0.73 RD8 0.83 RD7 0.80 RD9 0.74 RD3 0.91 RD2 0.76 RD1 0.67 TFL11 0.74 TFL10 0.63 TFL9 0.58 TFL12 0.56 RD5 0.87 RD4 0.84 RD6 0.68 Percentage of variance explained (%)
77.55
Kaiser‑Meyer‑Olkin 0.76 Bartlett’s test of sphericity approx (χ2)
1523.67
df 300 Significant 0.000 TFL: Transformational leadership style, RD: Readiness for change
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support the change and achieve the organisation’s objectives are referred to as transformational leaders.
Another study stated that leaders who may not be considered profoundly transformational but can supervise and handle a change plan carefully should stimulate commitment to the specific change corresponding to their behaviour.[47] Leadership helps guide the positive interaction between transformational direction and commitment to change.[48] Transformational leaders can encourage and support the change process, which assists by confirming the expectations that the proposed change represents the organisation’s position.[30]
Further, the study’s results are consistent with those of another study that indicated that effective transformational leaders can offer support that can change employees’ essential values, beliefs and perspectives so that they understand the change
proposed and accept it readily.[49] Transformational leaders who act as change agents are considered more effective in preparing employees to implement change. In the study, above on the effect of leadership on an organisation’s preparedness to change found that leadership behaviour had a constructive and notable relation with willingness to change and determined that the positions and practices in leadership behaviour play a significant role in creating employees’ readiness for the change desired.[49]
In theory, a healthcare staff perceives organisational support through transformational leadership, which is constructed on the standard of reciprocity.[50] If the team’s efforts are relatively reciprocal, they feel a strong sense of responsibility to care for the organisation and help it achieve its objectives. Staff members who trust their team have a positive attitude about the
Table 4: Summary of correlations of variables
IB IM IS IC IRC CRC ERC TFL IB
Pearson correlation Significant (two‑tailed)
IM Pearson correlation 0.46** Significant (two‑tailed) 0.00
IS Pearson correlation 0.53** 0.53** Significant (two‑tailed) 0.00 0.00
IC Pearson correlation 0.34** 0.54** 0.55** Significant (two‑tailed) 0.00 0.00 0.00
IRC Pearson correlation 0.34** 0.23* 0.48** 0.23* Significant (two‑tailed) 0.002 0.039 0.000 0.04
CRC Pearson correlation −0.08 −0.18 −0.25* −0.23* −0.36** Significant (two‑tailed) 0.48 0.11 0.02 0.04 0.00
ERC Pearson correlation 0.34** 0.32** 0.25* 0.30** 0.31** −0.25* Significant (two‑tailed) 0.00 0.00 0.03 0.01 0.01 0.02
TFL Pearson correlation 0.73** 0.81** 0.83** 0.78** 0.40** −0.23* 0.38** Significant (two‑tailed) 0.00 0.00 0.00 0.00 0.00 0.03 0.00
RD Pearson correlation 0.54** 0.37** 0.48** 0.37** 0.44** 0.13 0.71** 0.56** Significant (two‑tailed) 0.00 0.00 0.00 0.00 0.00 0.25 0.00 0.00
IB: Idealised behaviour, IS: Intellectual stimulation, IC: Individual consideration, IM: Inspirational motivation, IRC: Intentional readiness for change, CRC: Cognitive readiness for change, ERC: Emotional readiness for change, TFL: Transformational leadership style, RD: Readiness for change
Table 5: Results of linear regression analysis of effect of transformational leadership style on readiness for organisational change
Independent variable
Model summary ANOVA Coefficient
R2 Adjusted R2 Significant F change F Significant B β t Significant TFL 0.31 0.30 0.00 36.59 0.00 0.39 0.56 6.05 0.00 TFL: Transformational leadership style
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organisational results of the changes implemented. Therefore, transformational leadership is effective in improving subordinates’ behaviours in adapting to organisational changes and showing the relation between the two concepts.[51]
The study has several limitations that must be taken into account in interpreting the results. One is that the research was restricted to middle managers in the hospitals in one region in the KSA, and therefore, only limited generalisations can be made. Hence, the research should be carried out in other regions as well to yield more comprehensive results. The second limitation is that a cross‑sectional design was adopted that investigated the phenomenon at one point in time. A longitudinal design would support the conclusions further, given that human behaviour evolves continuously. Third, a single source was applied to measure all of the constructs; hence, the most significant limitation of the study was the potential effect of common method bias. While the R2 obtained for readiness for organisational change in healthcare was 30%, we can surmise that other significant variables, such as different types of leader behaviours, may influence the readiness for organisational change. For example, organisational change initiatives may be more directive in nature under transactional leadership,[52] and when the organisational changes are continuous or decentralised, servant leadership may be most appropriate.[53] Further, future research must consider leadership behaviour at various levels in the hierarchy. This includes employees’ perceptions. Such an analysis is expected to offer more thorough insight into organisational change readiness. Finally, it is also important to evaluate whether there are variables that moderate and/or mediate the relation between organisational change readiness and leadership style, such as the commitment to change and a culture that enhances the readiness for organisational change.
conclusIons There is limited empirical research in Saudi Arabia on the healthcare sector’s readiness for change and the role of transformational leadership. This research provided valuable information with respect to the relation between readiness for the change process and leadership behaviour.
The study outcomes indicated that a significant association exists between leadership behaviour and readiness for change. The literature available on this subject and these findings are consistent in demonstrating that leadership style has the ability to influence and establish an organisation’s readiness for change. Because of these relations, healthcare organisations’ should make it a priority to develop leadership talent that will motivate the workforce to implement effective organisational change. To implement transformational leadership within healthcare organisations effectively, various aspects must be taken into account to ensure that the resistance to change is minimal and the workforce accepts the change readily. Further, healthcare organisation managers usually are advised to ensure that they conduct continuous research and analysis to identify
the requirements and resources the evolving organisation needs based on the objectives of the change process required. In doing so, effective strategies can be formulated to ensure that the behaviours and actions are consistent with the healthcare system’s requirements and that organisational change is successful.
Consequently, this research also is valuable to healthcare policymakers and providers, as it offers information about the leadership behaviours necessary to optimise readiness for change that influence the intentions, attitudes and beliefs of these organisations’ members and help them accept and understand a change initiative. Moreover, healthcare policymakers could make use of this vital information to enhance their procedures and policies when carrying out the change process.
Financial support and sponsorship Nil.
Conflicts of interest There are no conflicts of interest.
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