Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature

Figures & data

Figure 1 Servant leadership attributes model.

Note: Reprinted with permission from Emerald Group Publishing Limited, originally published in Leadership & Organization Development Journal, Vol 23, Issue 3, © Emerald Group Publishing Limited 2002.²³

Table 1 Inclusion and exclusion criteria

Inclusion criteria	Exclusion criteria
Article is written in the English language	Article is written in a language other than English
Published in a peer-reviewed journal	Gray literature, thesis, essay, book review, letter, editorial, opinion, or journalistic article
Article describes an empirical study or is a theoretical review	Speculative article
Lean leadership or servant leadership is the main topic of the article	Lean or servant leadership is not the main theme of the article
Lean leadership and servant leadership are described in health care or, if an organization, in a hospital or health system	Servant leadership and Lean leadership described in industries other than health care
Article describes one or more aspects of leadership (origin, philosophy, values, characteristics, tools, organizational culture, and organizational outcome)

Figure 2 Article selection procedure.

Table 2 References reviewed by leadership style

Leadership style	References reviewed
Lean	Abuhejleh et al,^Citation1 Aij et al,^Citation11 Al-Balushi et al,^Citation8 Clark et al,^Citation3 Dahlgaard et al,^Citation34 Dannapfel et al,^Citation32 Dickson et al,^Citation41 Abuhejleh et al,^Citation46 Fine et al,^Citation35 Goodridge et al,^Citation17 Guimarães and Carvalhov,^Citation45 Johnson et al,^Citation42 Ljungblom,^Citation36 Mann,^Citation7 Merlino et al,^Citation4 Papadopoulos et al,^Citation9 Poksinska et al,^Citation47 and Toussaint and Berry^Citation37
Servant	Barbuto and Wheeler,^Citation48 Hanse et al,^Citation21 Huckabee and Wheeler,^Citation39 Parris and Peachey,^Citation28 Robinson,^Citation29 Russell and Stone,^Citation23 Sendjaya et al,^Citation30 Stone et al,^Citation20 Schwartz and Tumblin,^Citation44 Trastek et al,^Citation2 van Dierendonck,^Citation27 and Waterman^Citation31

Table 3 Comparison of Lean leadership and servant leadership

Leadership aspect	Lean	Servant
Origins	Based on Toyota Production System
	First described in 1980 by Womack and Jones	First described in 1970 by Greenleaf
	Roots in post-World War I training program	Roots in theological and philosophical belief systems
	Built upon long history of production systems (Henry Ford and Walter Edwards Deming)
Philosophy	Remove waste to maximize value	Serve others’ needs
	Commitment to respect	Develop a sustainable organization
	Focus on organization’s well being	Focus on leaders meeting the needs of others
	Qualification of employees	People-driven, person-oriented attitude
	Focus on process	Focus on people
Characteristics	Employee empowerment	Communication
		Listening
		Integrity
		Humility
	Self-development	Empathy
	Development of others	Appreciation of others
	Modesty	Healing
	Listening
	Openness
	Trust	Awareness
		Visibility
	Responsibility	Persuasion
		Influence
	Motivating	Conceptualization
	Modeling	Modeling
	Respect for people	Foresight
	Personal observation of work	Stewardship
	Observe	Trust
	Engage	Service
	Improve
	Create a vision	Commitment to growth of people
		Encouragement
		Empowerment
	Establish goals	Teaching
		Delegation
	Remove barriers	Vision
		Building community
		Pioneering
		Honesty
		Credibility
		Competence
Values	Continuous improvement	Humility
	Safety
	Quality
	Effectiveness
	Efficiency
	Respect for people	Respect for others
	Employee satisfaction
	Human development	Serve the community
	Employee empowerment
	Standardization	Quality of service
		Release of checklists
Tools	Kaizen events (rapid improvement events)	Personal values
	Value stream map	Moral core
	A3 framework	Characteristics
	PDCA cycle	Humility
		Authenticity
		Stewardship
		Vision
		Desire to serve others
	Just in time
	Kanban (inventory-control system to control the supply chain)
	Intelligent automation
	5-whys
	5S
	Strategy deployment
	Evaluation: shop-floor walking
	Ohno cycle
Organizational culture	Improvement culture	Open and trusting environment
	No blame approaches to mistakes and errors	Collaboration
	Problem is opportunity
	Doing the right thing	Transparency
	Doing more with less
	Transparency	Learning environment
		Room to learn and to make mistakes
		Employee empowerment
	Teamwork	Safe psychological environment
	Learning culture
Organizational performance	Higher competitive advantage	Sustainable organization
	Long term sustainability of the organization	Team effectiveness
		Increased teamwork
		More collaboration
	Tangible outputs:	Tangible outputs:
	Reduced error rates	High quality of care
		Reduction in costs
	Reduced waiting times	Enhance procedural justice
	Increased productivity
	Increased quality
	Reduced costs
	Reduced mortality rates
	Improved patient care
	Intangible outputs:	Intangible outputs:
	Increased employee motivation	Trust in the organization
		Increased patient safety
	Increased employee satisfaction	Increased patient satisfaction
	Improved patient safety	Increased employee empowerment
	Improved patient satisfaction	Increased organizational commitment of employees
	Employee empowerment
	Achieve perfection in processes	Employees become healthier, wiser, freer, and more
		autonomous

Abbreviation: PDCA, plan do check act.

Table 4 Ten characteristics and behaviors of servant leaders

Characteristic	Definition
Listening	Emphasizing the importance of communication and seeking to identify the will of the people
Empathy	Understanding others and accepting how and what they are
Healing	The ability to help make whole
Awareness	Being awake
Persuasion	Seeking to influence others relying on arguments not on positional power
Conceptualization	Thinking beyond the present day need and stretching it into a possible future
Foresight	Foreseeing outcomes of situations and working with intuition
Stewardship	Holding something in trust and serving the needs of others
Commitment to the growth of people	Nurturing the personal, professional, and spiritual growth of others
Building community	Emphasizing that local communities are essential in a person’s life

Note: Adapted with permission from Emerald Group Publishing Limited, originally published in Leadership & Organization Development Journal, Vol 17, Issue 7, © Emerald Group Publishing Limited 1996.¹⁹

Table 5 Functional and accompanying characteristics of servant leadership

Functional characteristics	Accompanying characteristics
1. Vision	1. Communication
2. Honesty	2. Credibility
3. Integrity	3. Competence
4. Trust	4. Stewardship
5. Service	5. Visibility
6. Modeling	6. Influence
7. Pioneering	7. Persuasion
8. Appreciation of others	8. Listening
9. Empowerment	9. Encouragement
	10. Teaching
	11. Delegation

Note: Adapted with permission from Emerald Group Publishing Limited, originally published in Leadership & Organization Development Journal, Vol 23, Issue 3, © Emerald Group Publishing Limited 2002.²³

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