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Exploring the Experiences of First-Time Health Care Leaders in Critical Leadership Roles: A Phenomenological Study A Dissertation Submitted to the Faculty of Drexel University by Olivia Yarbrough Stringer in partial fulfillment of the requirements for the degree of Doctor of Education June 2014

? Copyright 2014 Olivia Yarbrough Stringer. All Rights Reserved

Abstract

Exploring the Experiences of First-Time Heath Care Leaders in Critical Leadership

Roles: A Phenomenological Study

Olivia Yarbrough Stringer

Drexel University, June 2014

Chairperson: Kathy D. Geller

In health care, there is a shortage of experienced and skilled senior and executive health care leaders. Health care organizations are promoting and hiring individuals who may lack some of the requisite knowledge and senior-level leadership experience. Little is known about the lived experiences of these first-time senior and executive health care leaders during their entry into these roles.

The purpose of this study was to explore and describe the lived experiences, challenges, concerns, and perceptions of first-time senior-level health care leaders who have worked 6 months to 4 years in their first senior-level role in a health care organization. The following research questions guided this phenomenological qualitative study:

1. What is the lived experience of a novice health care leader in a critical leadership role for the first time?

2. How do these participants describe the challenges they faced and the leadership lessons they learned that influenced current actions in their roles?

3. What professional development efforts might offer a needed foundation for the initial success of other novices promoted into similar positions? The sample included nine novice senior health care leaders. Data were collected

using an interview, observation field notes, and artifacts. From these methods, four findings emerged: (a) first-time senior level health care leaders experienced daily personal feelings of inadequacy in their new roles; (b) multiple operations and requirements of multiple departments make up one system requiring multilevel leadership accountability; (c) organizational challenges for senior-level leaders in non-profit bureaucratic health care organizations are particularly discouraging and problematic; (d) individuals in middle-management positions who aspire to or are promoted to seniorlevel leader roles in health care organizations would benefit from mentoring programs and succession planning approaches.

Major conclusions were that hospital boards and chief executive officers (CEOs) need to reduce the anxiety, fear, and uncertainty experienced in the initial novice leaders' transitions by providing structured orientations with assigned peer partners and assuring an on-going structured leader development program and structured mentoring and coaching programs to provide stability.

This Ed.D. Dissertation Committee from The School of Education at Drexel University certifies that this is the approved version of the following dissertation:

Exploring the Experiences of First-Time Heath Care Leaders in Critical Leadership Roles: A Phenomenological Study

Olivia Yarbrough Stringer

Committee: ____________________________________ Kathy D. Geller, Ph.D. ____________________________________ W. Edward Bureau, Ph.D. ____________________________________ Susan A. Ostergard, Ed.D. ____________________________________ Date:

Dedication It is with great gratitude that I give thanks to God for giving me the mental and physical endurance to take this academic journey and the courage and determination to complete the journey. "The Lord is my strength and my might" (Exodus 15:2), without his guidance I am lost. I dedicate this dissertation to my wonderful and loving husband, Gerald, who has shown patience and impatience, support and threats, and encouragement in the good times and in the bad throughout the course of this journey. I also dedicate this dissertation to my sisters (Deloris and Ethel), brothers (Don Roy, Ricky, and Maurice), and to the memories of my mother (Katie), my dad (Benjamin), and my grandmother (Anna) who all believed in me as I grew up and inspired me to keep moving forward in spite of life challenges.

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Acknowledgements No achievement is done alone. I would like to say how grateful and thankful I am to the following people. Thank You To my committee--Dr. Kathy Geller, Dr. Edward Bureau, and Dr. Susan Ostergard--for their guidance; To my family (especially my husband, Gerald, and my daughter, Dwanne), friends, and co-workers for all their support; To the "DOKA+C" (study partners): Davin, Katrina, Stephanie, and Camille-- and my inspirational cohort buddy, Patricia; To the participants of this study for sharing their experiences and making this research possible.

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Table of Contents

LIST OF TABLES ............................................................................................................ vii LIST OF FIGURES ......................................................................................................... viii 1. INTRODUCTION TO THE RESEARCH ....................................................................1

Introduction to the Problem ...........................................................................................1 Statement of the Problem to Be Researched..................................................................3 Purpose and Significance of the Problem ......................................................................3 Research Questions ........................................................................................................4 The Conceptual Framework...........................................................................................5 Definition of Terms......................................................................................................13 Assumptions and Limitations ......................................................................................16 Summary ......................................................................................................................17 2. REVIEW OF THE LITERATURE .............................................................................19 Introduction ..................................................................................................................19 Literature Review.........................................................................................................19 Summary ......................................................................................................................51 3. RESEARCH METHODOLOGY.................................................................................54 Introduction ..................................................................................................................54 Research Design and Rationale ...................................................................................54 Site and Population ......................................................................................................58 Research Methods ........................................................................................................59

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Ethical Considerations .................................................................................................65 4. FINDINGS, RESULTS, AND INTERPRETATIONS................................................67

Findings........................................................................................................................69 Results and Interpretations.........................................................................................106 Summary ....................................................................................................................118 5. CONCLUSIONS AND RECOMMENDATIONS ....................................................119 Introduction ................................................................................................................119 Conclusions ................................................................................................................120 Recommendations ......................................................................................................125 Overall Summary .......................................................................................................128 LIST OF REFERENCES .................................................................................................130 APPENDIX A: LETTER OF INVITATION ..................................................................140 APPENDIX B: INTERVIEW PROTOCOL/SEMI-STRUCTURED QUESTIONS ......141 APPENDIX C: PHENOMENOLOGICAL RESEARCH PROCESS .............................145 APPENDIX D: FIELD JOURNAL DOCUMENT..........................................................146

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